Spine Sports and Pain Medicine, PC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SPINE SPORTS AND PAIN MEDICINE, PC

Doing business as

Physicians Resource Labs

Practice address

7900 W Jefferson Blvd
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 MEDICINEAs reported in NPPES

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

Authorized official

Name

Mr. Matthew Cavacini

Title

Ceo

Phone

(260) 969-6200

Specialties & licenses 1

Addresses

Other names 1

• Physicians Resource Labs Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Inquest Health System PC3 organizations share this tax ID, including this one

Part of

Inquest Health System PC

Other organizations with this tax ID 2

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

• Inquest Health System, PC

  • Pharmacy
  • Fort Wayne, IN
  • NPI 1427304567
  NPD tax ID
• Spine Sports and Pain Medicine, PC

  dba Doctors Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
  • NPI 1750516704
  NPD tax ID

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": "1780819755",
    "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",
            "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",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Resource Labs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrewa J Spiguzza, DDS
• Nicole Spillers
• Spinal Concepts, LLC
• Spine Center of Fort Wayne
• Spine Sports and Pain Medicine, PC (Doctors Medical Equipment)
• Spine Technology and Rehabilitation PC
• Spine Technology and Rehabilitation, P.C.
• Megan W. Spinks, LCSW
• Devin Scott Spivey, MD
• Roger E Sporre, MD

• Clinical Medical Laboratory in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Medical Laboratory in Indiana

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.