Provider Demographics
NPI:1881626117
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:PRESIDENT
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 1:6767 LAKE WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2566
Mailing Address - Country:US
Mailing Address - Phone:281-364-1122
Mailing Address - Fax:281-210-3450
Practice Address - Street 1:6767 LAKE WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2566
Practice Address - Country:US
Practice Address - Phone:281-364-1122
Practice Address - Fax:281-210-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106276208100000X
332B00000X, 335E00000X
TXM0199207QS0010X
TXJ1526207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00776YMedicare PIN