MED SPORTS VANTAGE PLLC NPI 1326587114

NPI Information

NPI: 1326587114
Provider Name: MED SPORTS VANTAGE PLLC

Doing Business As: MED SPORTS VANTAGE PLLC

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
210 S EAST ST STE 2
BRIGHTON, MI
ZIP 48116
Phone: (810) 626-3036
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MED SPORTS VANTAGE PLLC is a primary care clinic center in Brighton, MI. MED SPORTS VANTAGE PLLC NPI is 1326587114. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Med Sports Vantage Pllc.

The provider's business location address is:

210 S EAST ST STE 2
BRIGHTON, MI
ZIP 48116-592
Phone: (810) 626-3036
Fax: (810) 202-1130

The provider's authorized official is Rachel Lethorn .
The authorized official title is Ceo / Owner and has the following contact phone number (810) 626-3036.

The CLIA number assigned to this NPI record is 23D2135943 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2017 and was last updated on 3/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RA0401X	Internal Medicine	Addiction Medicine	5601003608	MICHIGAN	No
2	261QM2500X	Clinic/Center	Medical Specialty	5601003608	MICHIGAN	No
3	363A00000X	Physician Assistant		5601003608	MICHIGAN	No
4	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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