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General NPI Number Information
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NPI Number | 1154412419
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Entity Type | Organization
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Legal Business Name | SOUTHPORT ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 3 HANDLEY ST
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City | PERRY
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State | NY
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Zip | 14530-1342
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Country | US
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Telephone | 585-237-2980
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Fax | 585-237-5570
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Provider Business Mailing Address
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Address Line | 3 HANDLEY ST
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City | PERRY
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State | NY
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Zip | 14530-1342
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Country | US
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Telephone | 585-237-2980
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Fax | 585-237-5570
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JANET AUVIL
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Credential |
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Telephone | 910-803-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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