Organization
SPINE SPORTS AND PAIN MEDICINE, PC
Active
Parent organization
SPINE SPORTS AND PAIN MEDICINE
Other names
Physicians Resource Labs
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPINE SPORTS AND PAIN MEDICINE
Authorized official
MR. MATTHEW CAVACINI (CEO)
(260) 969-6200
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD, 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
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
05/20/2009
Last updated
05/20/2009
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