Provider Demographics
NPI:1457335374
Name:ORTHOPEDIC CARE CENTER , PA
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE CENTER , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUBOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAROLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-2222
Mailing Address - Street 1:2121 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7409
Mailing Address - Country:US
Mailing Address - Phone:713-522-2222
Mailing Address - Fax:713-521-1148
Practice Address - Street 1:2121 OAKDALE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-522-2222
Practice Address - Fax:713-521-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6505207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176906901Medicaid
TX00425XMedicare PIN
00425XMedicare ID - Type Unspecified
TX176906901Medicaid