Provider Demographics
NPI:1952664419
Name:HLC ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:HLC ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-539-2663
Mailing Address - Street 1:1501 RIVER POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2860
Mailing Address - Country:US
Mailing Address - Phone:936-539-2663
Mailing Address - Fax:
Practice Address - Street 1:1501 RIVER POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2860
Practice Address - Country:US
Practice Address - Phone:936-539-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4277207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C14895Medicare UPIN
TX6759720001Medicare NSC
TXTXB162784Medicare PIN