Organization
SPINE SPORTS AND PAIN MEDICINE, PC
Active
Parent organization
SPINE SPORTS AND PAIN MEDICINE, PC
Other names
Doctors Medical Equipment
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPINE SPORTS AND PAIN MEDICINE, PC
Authorized official
MATTHEW CAVACINI (CEO)
(260) 969-6200
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 304, FORT WAYNE, IN 46804-4128
(260) 969-6200
(260) 969-6201
Mailing address
PO BOX 8857, FORT WAYNE, IN 46898-8857
(260) 969-6200
(260) 969-6201
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
50004446A
IN
Other
Enumeration date
05/20/2009
Last updated
05/20/2009
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