Provider Demographics
NPI:1558343806
Name:KSF ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:KSF ORTHOPAEDIC CENTER PA
Other - Org Name:KANT STUART FITZGERALD ORTHOPAEDIC ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-880-1411
Mailing Address - Street 1:PO BOX 4356
Mailing Address - Street 2:DEPT 665
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:281-440-6960
Mailing Address - Fax:281-440-6205
Practice Address - Street 1:17270 RED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2632
Practice Address - Country:US
Practice Address - Phone:281-440-6960
Practice Address - Fax:281-440-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X, 208VP0000X
TX261QM1300X
TXN/A332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082981401Medicaid
TX082981401Medicaid
TX0398000001Medicare NSC