Provider Demographics
NPI:1780867358
Name:ORTHOPEDIC CARE CENTER PA
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LUBOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-6035
Mailing Address - Street 1:2121 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7409
Mailing Address - Country:US
Mailing Address - Phone:713-522-6035
Mailing Address - Fax:713-521-7406
Practice Address - Street 1:2121 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7409
Practice Address - Country:US
Practice Address - Phone:713-522-6035
Practice Address - Fax:713-521-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6505207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6398Medicare PIN
TXG58497Medicare UPIN