Provider Demographics
NPI:1972832707
Name:SPORTS MEDICINE EXPRESS PLLC
Entity type:Organization
Organization Name:SPORTS MEDICINE EXPRESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-726-3440
Mailing Address - Street 1:2875 W RAY RD
Mailing Address - Street 2:SUITE 6, BOX #405
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3524
Mailing Address - Country:US
Mailing Address - Phone:480-726-3440
Mailing Address - Fax:
Practice Address - Street 1:2875 W RAY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3524
Practice Address - Country:US
Practice Address - Phone:480-726-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center