Basic Information
| Provider Information | |||||||||
| NPI: | 1346244688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS ORTHOPEDICS SPORTS & REHABILITATION ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 SETON CENTER PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787594107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124391000 | ||||||||
| FaxNumber: | 5124391081 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 SETON CENTER PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787594107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124391000 | ||||||||
| FaxNumber: | 5124391081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | KINMAN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5124391011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 00810548-03 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | CP2307 | 01 | TX | RAILROAD MEDICARE | OTHER | 093712001 | 05 | TX | MEDICAID | CG6742 | 01 | TX | RAILROAD MEDICARE | OTHER |