Ice20 - Triad Sports Group, Llc

LBN: Ice20 - Triad Sports Group, Llc
Ice20 - Triad Sports Group, Llc is an health care organization with primary practice located at 4690 Calle Quetzal , Camarillo CA 93012-8558. The organization recently has only one registered license in Suppliers / Durable Medical Equipment & Medical Supplies, which is considered as the primary health care specialty. Ice20 - Triad Sports Group, Llc can be contacted via phone (805) 857-4172, or through Smith, Brad L via phone (805) 857-4172.

Contact Information

Primary practice address
4690 Calle Quetzal Camarillo CA 93012-8558
Phone: (805) 857-4172
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Smith, Brad L
Phone: (805) 857-4172

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X

Profile Details

NPI number 1285964932
LBN Legal business name Ice20 - Triad Sports Group, Llc
DBA Doing business as
Authorized official Smith, Brad L
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 31st, 2009
Last updated Oct 7th, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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