Provider Demographics
NPI:1922133834
Name:SPORTS OCCUPATIONAL & KNEE SURGERY PA
Entity Type:Organization
Organization Name:SPORTS OCCUPATIONAL & KNEE SURGERY PA
Other - Org Name:PETER F HOLMES MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-696-9000
Mailing Address - Street 1:9150 HUEBNER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-696-9000
Mailing Address - Fax:
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-696-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9578207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00589ROtherBLUE CROSS BLUE SHIELD GR
TX00589ROtherBLUE CROSS BLUE SHIELD GR