Provider Demographics
NPI:1780787861
Name:ORANGE MEDICAL SURGICAL ASSOC LLP
Entity type:Organization
Organization Name:ORANGE MEDICAL SURGICAL ASSOC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-883-3201
Mailing Address - Street 1:610 STRICKLAND
Mailing Address - Street 2:SUITE 200-C
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4790
Mailing Address - Country:US
Mailing Address - Phone:409-883-3201
Mailing Address - Fax:409-883-3220
Practice Address - Street 1:610 STRICKLAND DR
Practice Address - Street 2:SUITE 290C
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4786
Practice Address - Country:US
Practice Address - Phone:409-883-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033BMOtherBLUE CROSS BLUE SHEILD
TX080394201Medicaid
TX080394201Medicaid