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General NPI Number Information
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NPI Number | 1588649842
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE GRANT, INC
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 323 E TOWN ST
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City | COLUMBUS
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State | OH
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Zip | 43215-4774
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Country | US
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Telephone | 614-461-8174
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Fax | 614-461-9155
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Provider Business Mailing Address
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Address Line | 323 E TOWN ST
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City | COLUMBUS
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State | OH
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Zip | 43215-4774
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Country | US
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Telephone | 614-461-8174
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Fax | 614-461-9155
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAYMOND J TESNER
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Credential | MD
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Telephone | 614-461-8174
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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 | OH
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