NPIMap

Organization Active NPI

Spine Sports and Pain Medicine, PC

Doing business as Doctors Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
National Provider Identifier
1750516704
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
50004446A Issued in IN
Legal business name
SPINE SPORTS AND PAIN MEDICINE, PC
Doing business as
Doctors Medical Equipment
Practice address
7900 W Jefferson Blvd
Suite 304
Fort Wayne, IN 46804-4128
Phone
(260) 969-6200
Fax
(260) 969-6201
NPI assigned
May 20, 2009
Last updated
May 20, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SPINE SPORTS AND PAIN MEDICINE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Authorized official

Name
Matthew Cavacini
Title
Ceo
Phone
(260) 969-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 50004446A IN Primary

Addresses

Primary practice location

7900 W Jefferson Blvd
Suite 304
Fort Wayne, IN 46804-4128

Mailing address

PO Box 8857
Fort Wayne, IN 46898-8857
Phone (260) 969-6200

Other names 1

  • Doctors Medical Equipment Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spine Sports and Pain Medicine PC3 organizations share this tax ID, including this one
Part of
Spine Sports and Pain Medicine PC

Other organizations with this tax ID 2

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

Locations

7900 W Jefferson Blvd
Ste 304
Fort Wayne, IN 46804
Phone (260) 435-6200

NPI Registry JSON

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1750516704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8857",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468988857",
            "telephone_number": "260-969-6200",
            "fax_number": "260-969-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD",
            "address_2": "SUITE 304",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-969-6200",
            "fax_number": "260-969-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SPORTS AND PAIN MEDICINE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPINE SPORTS AND PAIN MEDICINE, PC",
        "enumeration_date": "2009-05-20",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "CAVACINI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-969-6200"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "50004446A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; 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.