Provider Demographics
NPI:1609830595
Name:FONDREN ORTHOPEDIC GROUP L.L.P.
Entity Type:Organization
Organization Name:FONDREN ORTHOPEDIC GROUP L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-799-2300
Mailing Address - Street 1:7401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3395
Practice Address - Street 1:7401 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4509
Practice Address - Country:US
Practice Address - Phone:713-799-2300
Practice Address - Fax:713-794-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530699OtherBLUE CROSS & BLUE SHIELD ORTHOTICS
TX00H7NOtherBLUE CROSS & BLUE SHIELD
TX00H7NOtherMEDICARE
TX121422301Medicaid
TX530699OtherBLUE CROSS & BLUE SHIELD ORTHOTICS
TX121422301Medicaid