NPIMap

Organization Active NPI

Valley Sports Physicians & Orthopedic Medicine

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Avon, CT
National Provider Identifier
1871799635
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
040264 Issued in CT
Legal business name
VALLEY SPORTS PHYSICIANS & ORTHOPEDIC MEDICINE
Practice address
54 W Avon Rd
Suite 202
Avon, CT 06001-3680
Phone
(860) 675-0357
Fax
(860) 675-0358
NPI assigned
Jun 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Miss Nichole Wedderburn
Title
Office / Billing Manager
Phone
(860) 675-0357

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204C00000X 040264 CT Primary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204C00000X 000406 CT
Sports Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QS0010X 040264 CT
Sports Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QS0010X 000406 CT

Addresses

Primary practice location

54 W Avon Rd
Suite 202
Avon, CT 06001-3680

Mailing address

54 W Avon Rd
Suite 202
Avon, CT 06001-3680
Phone (860) 675-0357

Other names 1

  • Valley Sports Physicians Doing business as

National Provider Directory

National Provider Directory

Locations

54 W Avon Rd
Ste 202
Avon, CT 06001
Phone (860) 675-0357

59 Sycamore St
Fl 3
Glastonbury, CT 06033

59 Sycamore St
Glastonbury, CT 06033
Phone (860) 430-9690

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1871799635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 W AVON RD",
            "address_2": "SUITE 202",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013680",
            "telephone_number": "860-675-0357",
            "fax_number": "860-675-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 W AVON RD",
            "address_2": "SUITE 202",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013680",
            "telephone_number": "860-675-0357",
            "fax_number": "860-675-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY SPORTS PHYSICIANS & ORTHOPEDIC MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "WEDDERBURN",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "OFFICE / BILLING MANAGER",
        "authorized_official_telephone_number": "860-675-0357",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CT",
            "license": "040264",
            "primary": true
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CT",
            "license": "000406",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CT",
            "license": "040264",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CT",
            "license": "000406",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Sports Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.