GEAUGA SPORTS MEDICINE LLC NPI 1396746970

NPI Information

NPI: 1396746970
Provider Name: GEAUGA SPORTS MEDICINE, LLC
Classification: Preventive Medicine - 2083S0010X
Entity Type: Organization

Specialization: Sports Medicine

Address:
13207 RAVENNA RD
CHARDON, OH
ZIP 44024
Phone: (440) 285-6452
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GEAUGA SPORTS MEDICINE, LLC is a sports medicine preventive medicine in Chardon, OH. The provider is a preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. GEAUGA SPORTS MEDICINE, LLC NPI is 1396746970. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13207 RAVENNA RD
CHARDON, OH
ZIP 44024-032
Phone: (440) 285-6452
Fax: (440) 285-1796

The provider's authorized official is Michael J Kelis .
The authorized official title is President and has the following contact phone number (440) 285-6452.

The enumeration date for this NPI number is 8/9/2005 and was last updated on 7/21/2022.

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	2083S0010X	Preventive Medicine	Sports Medicine		OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	250006704	OTHER	OHIO	RR MEDICARE

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: 4/28/2024

NPI Synchronization or Removal

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