Provider Demographics
NPI:1407079585
Name:ORSAK MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:ORSAK MEDICAL ASSOCIATION
Other - Org Name:FRIENDSWOOD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ORSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-485-9034
Mailing Address - Street 1:300 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3823
Mailing Address - Country:US
Mailing Address - Phone:281-485-9034
Mailing Address - Fax:281-485-9807
Practice Address - Street 1:300 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3823
Practice Address - Country:US
Practice Address - Phone:281-485-9034
Practice Address - Fax:281-485-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG30196Medicare UPIN
TX00788NMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER