Provider Demographics
NPI:1972686814
Name:ORTHO KINETICS, LTD
Entity Type:Organization
Organization Name:ORTHO KINETICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8801
Mailing Address - Street 1:7301 FANNIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4807
Mailing Address - Country:US
Mailing Address - Phone:713-797-0011
Mailing Address - Fax:713-797-0010
Practice Address - Street 1:11201 RICHMOND AVE # A106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6653
Practice Address - Country:US
Practice Address - Phone:713-983-7324
Practice Address - Fax:713-983-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091478332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0091478OtherMED DEVICE DISTRIBUTOR