=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245945328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE SPINE AND SPORTS HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 02/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2795 W NEW HAVEN AVE
-----------------------------------------------------
City | WEST MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32904-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-622-8626
-----------------------------------------------------
Fax | 800-813-9164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 629 HUMMINGBIRD DR
-----------------------------------------------------
City | INDIALANTIC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32903-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-465-9363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | HART MEYRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-340-9039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------