| Innovative Sports Medicine | |
|
1525 E Republic Rd Suite A115 Springfield MO 65804-6527 | |
| (417) 882-0215 | |
| Not Available |
| Full Name | Innovative Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1525 E Republic Rd, Springfield, Missouri |
| Authorized Official Name and Position | Jeremy J Reed (PRESIDENT) |
| Authorized Official Contact | 4178820215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Sports Medicine 5912 S Stockton Ave Springfield MO 65804-7559 Ph: (417) 882-0215 | Innovative Sports Medicine 1525 E Republic Rd Suite A115 Springfield MO 65804-6527 Ph: (417) 882-0215 |
| NPI Number | 1922377274 |
|---|---|
| Provider Enumeration Date | 12/15/2011 |
| Last Update Date | 12/15/2011 |
| Medicare PECOS PAC ID | 7214194893 |
|---|---|
| Medicare Enrollment ID | O20120209000356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922377274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 2007006893 (Missouri) | Primary |
| Provider Name | Jeremy J Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487850053 PECOS PAC ID: 4486730272 Enrollment ID: I20091008000254 |
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