Healthcare Provider Details

I. General information

NPI: 1609065218
Provider Name (Legal Business Name): MT VERNON SPORTS AND FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 COSHOCTON AVE STE E
MOUNT VERNON OH
43050-6400
US

IV. Provider business mailing address

1320 COSHOCTON AVE STE E
MOUNT VERNON OH
43050-6400
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-8001
  • Fax: 740-392-8008
Mailing address:
  • Phone: 740-392-8001
  • Fax: 740-392-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35060676
License Number StateOH

VIII. Authorized Official

Name: JAMES E STURMI
Title or Position: DOCTOR
Credential: MD
Phone: 740-392-8001