Organization
ACTIVE ATHLETE SPORTS MEDICINE PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRICIA ROBERTS (MANAGER)
(812) 949-3482
Entity
Organization
Contact information
Practice address
3891 CHARLESTOWN RD, NEW ALBANY, IN 47150-9562
(812) 949-3482
(812) 812-9418
Mailing address
3891 CHARLESTOWN ROAD, NEW ALBANY, IN 47150
(812) 949-3482
(812) 812-9418
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01033436A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100327800
—
IN
Enumeration date
11/24/2008
Last updated
02/24/2009
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