Provider Demographics
NPI:1205866605
Name:HOUSTON ORTHOPEDIC SURGERY & SPORTS MEDICINE, P.C.
Entity Type:Organization
Organization Name:HOUSTON ORTHOPEDIC SURGERY & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-953-4563
Mailing Address - Street 1:3051 WATSON BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8536
Mailing Address - Country:US
Mailing Address - Phone:478-953-4563
Mailing Address - Fax:
Practice Address - Street 1:3051 WATSON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8536
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-971-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023069207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 3323Medicare UPIN
GA1255810001Medicare NSC