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General NPI Number Information
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NPI Number | 1649604075
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Entity Type | Organization
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Legal Business Name | THE SPORTS & SPINE CENTER PC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 7654 SW MOHAWK ST BLDG K
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City | TUALATIN
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State | OR
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Zip | 97062-8119
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Country | US
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Telephone | 503-691-2000
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Fax | 503-691-2001
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Provider Business Mailing Address
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Address Line | 7654 SW MOHAWK ST BLDG K
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City | TUALATIN
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State | OR
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Zip | 97062-8119
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Country | US
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Telephone | 503-691-2000
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Fax | 503-691-2001
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JIMMY D HUEBERT
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Credential | MD
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Telephone | 503-691-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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