Provider Demographics
NPI:1225382633
Name:EAST HOUSTON ORTHOPEDICS & SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:EAST HOUSTON ORTHOPEDICS & SPORTS MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:713-453-6909
Mailing Address - Street 1:12930 EAST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5710
Mailing Address - Country:US
Mailing Address - Phone:713-453-6909
Mailing Address - Fax:713-453-7627
Practice Address - Street 1:4500 E SAM HOUSTON PKWY S
Practice Address - Street 2:120
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3959
Practice Address - Country:US
Practice Address - Phone:281-487-7300
Practice Address - Fax:281-487-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty