Provider Demographics
NPI:1043423130
Name:CREEDMOOR ORTHOPEDICS, P.A.
Entity Type:Organization
Organization Name:CREEDMOOR ORTHOPEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CREEDMOOR ORTHOPEDICS, PA
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:956-207-6458
Mailing Address - Street 1:4212 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE#210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3735
Mailing Address - Country:US
Mailing Address - Phone:210-448-1140
Mailing Address - Fax:210-448-1144
Practice Address - Street 1:4212 E SOUTHCROSS BLVD
Practice Address - Street 2:STE# 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3735
Practice Address - Country:US
Practice Address - Phone:210-448-1140
Practice Address - Fax:210-448-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4234207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081147301Medicaid
TX00784KMedicare ID - Type Unspecified
00784KMedicare PIN
E93949Medicare UPIN
00784 52Medicare PIN
TXE93949Medicare UPIN