NPIMap

Organization Active NPI

Lifebridge Sports Medicine and Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Middle River, MD
National Provider Identifier
1487289245
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
LIFEBRIDGE SPORTS MEDICINE AND REHABILITATION LLC
Practice address
1364 Martin Blvd Ste 5
Middle River, MD 21220-4104
Phone
(410) 686-3600
Fax
(410) 686-1056
NPI assigned
Mar 11, 2020
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael E Tarvin
Title
Vice President
Phone
(717) 972-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

1364 Martin Blvd Ste 5
Middle River, MD 21220-4104

Mailing address

4714 Gettysburg Rd
Mechanicsburg, PA 17055-4325
Phone (717) 972-1100

National Provider Directory

National Provider Directory
Tax ID family
Lifebridge Sports Medicine Rehabilitation LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

1364 Martin Blvd
Ste 5
Middle River, MD 21220
Phone (410) 686-3600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1487289245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 MARTIN BLVD STE 5",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212204104",
            "telephone_number": "410-686-3600",
            "fax_number": "410-686-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE SPORTS MEDICINE AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middle River, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.