Athletics Sports Medicine | NPI 1144339334

Key facts

NPI: 1144339334
Entity type: Organization (NPI type 2)
Primary specialty: Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
License: 1999135803 (MO)
Legal business name: ATHLETICS SPORTS MEDICINE
Practice address: 7508 Big Bend Blvd
Saint Louis, MO 63119-2104
Phone: (314) 341-4931
Fax: (314) 647-1964
NPI assigned: Aug 30, 2006
Organization subpart: No

Authorized official

Name: Dr. Cyd Charisse Williams, M.D.
Title: Owner/Physician
Phone: (314) 647-4880

National Provider Directory

Locations

7508 Big Bend Blvd
Saint Louis, MO 63119
Phone (314) 647-4880

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Sports Medicine (Neuromusculoskeletal Medicine) Physician Group: 193400000X SINGLE SPECIALTY GROUP	204C00000X	1999135803	MO	Yes

Addresses

Primary practice location

7508 Big Bend Blvd
Saint Louis, MO 63119-2104

Mailing address

7508 Big Bend Blvd
Saint Louis, MO 63119-2104
Phone (314) 341-4931

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144339334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7508 BIG BEND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192104",
            "telephone_number": "314-341-4931",
            "fax_number": "314-647-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7508 BIG BEND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192104",
            "telephone_number": "314-341-4931",
            "fax_number": "314-647-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETICS SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CYD CHARISSE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "314-647-4880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "MO",
            "license": "1999135803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

All providers in Saint Louis, MO · Sports Medicine (Neuromusculoskeletal Medicine) Physician in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.