MEDICARE: ALLEN SPINE AND SPORTS MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1174960124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN SPINE AND SPORTS MEDICINE, PC

Provider Business Mailing Address
First Line	:	PO BOX 1568
Second Line	:
City	:	WRIGHTSVILLE BEACH
State	:	NC
Zip	:	28480-1568
Country	:	US
Telephone Number	:	910-515-1506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 ALLENS LN STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-3662
Country	:	US
Telephone Number	:	910-515-1506
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	JOANNE BELL ALLEN
Credential	:	MD
Telephone Number	:	910-515-1506

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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