Provider Demographics
NPI:1912460874
Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Entity type:Organization
Organization Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-264-3388
Mailing Address - Street 1:218 N I ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5701 21ST AVE W STE 3
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5605
Practice Address - Country:US
Practice Address - Phone:805-928-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty