Provider Demographics
NPI:1417066655
Name:MEDICAL CENTER ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:MEDICAL CENTER ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-698-0607
Mailing Address - Street 1:9512 MAJESTIC OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3449
Mailing Address - Country:US
Mailing Address - Phone:210-698-0607
Mailing Address - Fax:210-614-7745
Practice Address - Street 1:9512 MAJESTIC OAK CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3449
Practice Address - Country:US
Practice Address - Phone:210-698-0607
Practice Address - Fax:210-614-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1094207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25255Medicare UPIN
TX00J49HMedicare PIN