Provider Demographics
NPI:1447688080
Name:SPORTS MEDICAL SERVICES, S.C.
Entity type:Organization
Organization Name:SPORTS MEDICAL SERVICES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-259-6605
Mailing Address - Street 1:500 W CENTRAL RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2347
Mailing Address - Country:US
Mailing Address - Phone:847-259-6605
Mailing Address - Fax:847-259-8071
Practice Address - Street 1:500 W CENTRAL RD
Practice Address - Street 2:STE. 103
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2347
Practice Address - Country:US
Practice Address - Phone:847-259-6605
Practice Address - Fax:847-259-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0426169892081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty