Provider Demographics
NPI:1356947626
Name:STERLING RIDGE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:STERLING RIDGE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-364-1122
Mailing Address - Street 1:750 FISH CREEK THOROUGHFARE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 FISH CREEK THOROUGHFARE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-6830
Practice Address - Country:US
Practice Address - Phone:936-272-0790
Practice Address - Fax:936-272-0791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STERLING RIDGE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7784300003OtherCGS-DME JURISDICTION C