Provider Demographics
NPI:1164848420
Name:ORTHO KINEMATICS
Entity Type:Organization
Organization Name:ORTHO KINEMATICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CLIENT DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-334-5490
Mailing Address - Street 1:110 WILD BASIN RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3339
Mailing Address - Country:US
Mailing Address - Phone:512-334-5490
Mailing Address - Fax:512-334-5500
Practice Address - Street 1:110 WILD BASIN RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-3339
Practice Address - Country:US
Practice Address - Phone:512-334-5490
Practice Address - Fax:512-334-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology