Provider Demographics
NPI:1558611764
Name:OAKBEND MEDICAL GROUP
Entity Type:Organization
Organization Name:OAKBEND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-238-7870
Mailing Address - Street 1:4911 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5320
Mailing Address - Country:US
Mailing Address - Phone:281-238-7870
Mailing Address - Fax:281-633-4985
Practice Address - Street 1:7830 W. GRAND PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5818
Practice Address - Country:US
Practice Address - Phone:281-633-4940
Practice Address - Fax:281-633-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6701330001Medicare NSC