Provider Demographics
NPI:1952360745
Name:CENTER FOR ORTHOPAEDIC SPECIALTIES PA
Entity type:Organization
Organization Name:CENTER FOR ORTHOPAEDIC SPECIALTIES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUEHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-774-0411
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:979-774-0411
Mailing Address - Fax:979-776-0508
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:SUITE 255
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-774-0411
Practice Address - Fax:979-776-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016DXOtherBCBS
TX080593901Medicaid
TX080593901Medicaid
TX5446320001Medicare NSC