Healthcare Provider Details

I. General information

NPI: 1376642926
Provider Name (Legal Business Name): MAJOR SPORTS AND MUSCULOSKELETAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WEST WASHINGTON
SHELBYVILLE IN
46176
US

IV. Provider business mailing address

1626 E STATE ROAD 44 STE A
SHELBYVILLE IN
46176-4057
US

V. Phone/Fax

Practice location:
  • Phone: 317-421-3265
  • Fax:
Mailing address:
  • Phone: 317-421-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. JOHN HORNER
Title or Position: CEO
Credential:
Phone: 317-392-3211