Provider Demographics
NPI:1982700795
Name:SAN ANGELO SUMMIT ORTHOPEDICS INC
Entity Type:Organization
Organization Name:SAN ANGELO SUMMIT ORTHOPEDICS INC
Other - Org Name:SAN ANGELO SUMMIT ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-227-8309
Mailing Address - Street 1:3150 APPALOOSA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901
Mailing Address - Country:US
Mailing Address - Phone:325-227-8309
Mailing Address - Fax:325-227-8313
Practice Address - Street 1:3150 APPALOOSA CIRCLE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901
Practice Address - Country:US
Practice Address - Phone:325-227-8309
Practice Address - Fax:325-227-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1468207X00000X
TXPA02057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44226Medicare UPIN