Provider Demographics
NPI:1225270689
Name:ASSOCIATED ORTHOPAEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:ASSOCIATED ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-326-8611
Mailing Address - Street 1:5757 WARREN PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4274
Mailing Address - Country:US
Mailing Address - Phone:214-618-5502
Mailing Address - Fax:214-618-5503
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:214-618-5502
Practice Address - Fax:214-618-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6237380001Medicare NSC