Provider Demographics
NPI:1386963932
Name:CENTER FOR HEALTH & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR HEALTH & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-240-0442
Mailing Address - Street 1:201 VILLAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRUIT COVE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3876
Mailing Address - Country:US
Mailing Address - Phone:904-240-0442
Mailing Address - Fax:
Practice Address - Street 1:201 VILLAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:FRUIT COVE
Practice Address - State:FL
Practice Address - Zip Code:32259-3876
Practice Address - Country:US
Practice Address - Phone:904-240-0442
Practice Address - Fax:904-240-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89577207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care