Provider Demographics
NPI:1346244688
Name:TEXAS ORTHOPEDICS SPORTS & REHABILITATION ASSOCIATES PA
Entity Type:Organization
Organization Name:TEXAS ORTHOPEDICS SPORTS & REHABILITATION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-439-1011
Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4107
Mailing Address - Country:US
Mailing Address - Phone:512-439-1000
Mailing Address - Fax:512-439-1081
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4107
Practice Address - Country:US
Practice Address - Phone:512-439-1000
Practice Address - Fax:512-439-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00810548-03207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCP2307OtherRAILROAD MEDICARE
TX093712001Medicaid
TXCG6742OtherRAILROAD MEDICARE
TX00231RMedicare PIN
TX093712001Medicaid
TX0366280002Medicare NSC