Provider Demographics
NPI:1245523133
Name:ORTHOPAEDIC SPORTS MEDICINE CENTER PLLC
Entity type:Organization
Organization Name:ORTHOPAEDIC SPORTS MEDICINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-994-8983
Mailing Address - Street 1:4865 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2476
Mailing Address - Country:US
Mailing Address - Phone:956-994-8983
Mailing Address - Fax:956-994-8967
Practice Address - Street 1:4865 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2476
Practice Address - Country:US
Practice Address - Phone:956-994-8983
Practice Address - Fax:956-994-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty