Provider Demographics
NPI:1497833966
Name:SPORT & SPINE CLINIC LP
Entity Type:Organization
Organization Name:SPORT & SPINE CLINIC LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZIED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2447
Mailing Address - Country:US
Mailing Address - Phone:713-297-7000
Mailing Address - Fax:713-297-7090
Practice Address - Street 1:133 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:WI
Practice Address - Zip Code:54437
Practice Address - Country:US
Practice Address - Phone:715-267-4583
Practice Address - Fax:715-267-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI526599Medicare Oscar/Certification