Provider Demographics
NPI:1649604448
Name:XSPORTSMED LLC
Entity type:Organization
Organization Name:XSPORTSMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-230-1305
Mailing Address - Street 1:217 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1526
Mailing Address - Country:US
Mailing Address - Phone:760-230-1305
Mailing Address - Fax:
Practice Address - Street 1:619 S VULCAN AVE STE 104
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3653
Practice Address - Country:US
Practice Address - Phone:760-230-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71584332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies