Provider Demographics
NPI:1417033622
Name:ORTHOPEDIC & SPORTS MEDICINE ASSOCIATES L.L.P.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS MEDICINE ASSOCIATES L.L.P.
Other - Org Name:DURABLE MEDICAL EQUIPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-870-7936
Mailing Address - Street 1:321 N HIGHLAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7371
Mailing Address - Country:US
Mailing Address - Phone:903-870-7936
Mailing Address - Fax:903-957-0367
Practice Address - Street 1:321 N HIGHLAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7371
Practice Address - Country:US
Practice Address - Phone:903-870-7936
Practice Address - Fax:903-957-0367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC & SPORTS MEDICINE ASSOCIATES L.L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280904802Medicaid
TX1216390001Medicare NSC