Healthcare Provider Details

I. General information

NPI: 1386963932
Provider Name (Legal Business Name): CENTER FOR HEALTH & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE OAKS DR
FRUIT COVE FL
32259-3876
US

IV. Provider business mailing address

201 VILLAGE OAKS DR
FRUIT COVE FL
32259-3876
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0442
  • Fax: 904-240-0471
Mailing address:
  • Phone: 904-240-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME89577
License Number StateFL

VIII. Authorized Official

Name: DR. ROSS OSBORN
Title or Position: OWNER
Credential: MD
Phone: 904-240-0442