Provider Demographics
NPI:1164661369
Name:CY-FAIR BONE AND JOINT, LLP
Entity Type:Organization
Organization Name:CY-FAIR BONE AND JOINT, LLP
Other - Org Name:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-664-2107
Mailing Address - Street 1:11800 FM 1960 WEST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:281-664-2107
Mailing Address - Fax:281-955-5875
Practice Address - Street 1:22485 TOMBALL PKWY
Practice Address - Street 2:SUITE 2100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1551
Practice Address - Country:US
Practice Address - Phone:281-664-2107
Practice Address - Fax:281-955-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00897ROtherMEDICARE PTAN
TX5500520003Medicare NSC