Basic Information
Provider Information
NPI: 1376642926
EntityType: 2
ReplacementNPI:  
OrganizationName: MAJOR SPORTS AND MUSCULOSKELETAL CARE
LastName:  
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Mailing Information
Address1: 1626 E STATE ROAD 44
Address2: STE A
City: SHELBYVILLE
State: IN
PostalCode: 461764057
CountryCode: US
TelephoneNumber: 3174212012
FaxNumber:  
Practice Location
Address1: 157 WEST WASHINGTON
Address2:  
City: SHELBYVILLE
State: IN
PostalCode: 46176
CountryCode: US
TelephoneNumber: 3174213265
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/21/2006
LastUpdateDate: 07/21/2022
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AuthorizedOfficialLastName: HORNER
AuthorizedOfficialFirstName: JOHN
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AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3173923211
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
204C00000X INY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine 

ID Information
IDTypeStateIssuerDescription
20047533005IN MEDICAID


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