Provider Demographics
NPI:1124171368
Name:HOLZKNECHT FAMILY ORTHOPEDICS OF S TEXAS
Entity type:Organization
Organization Name:HOLZKNECHT FAMILY ORTHOPEDICS OF S TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLZKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-728-0571
Mailing Address - Street 1:6801 MCPHERSON RD STE 217
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6443
Mailing Address - Country:US
Mailing Address - Phone:956-728-0571
Mailing Address - Fax:956-728-0620
Practice Address - Street 1:6801 MCPHERSON RD STE 217
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6443
Practice Address - Country:US
Practice Address - Phone:956-728-0571
Practice Address - Fax:956-728-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDL3343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4790OtherBLUE CROSS BLUE SHIELD
TX00903QMedicare ID - Type Unspecified
TX8F4790OtherBLUE CROSS BLUE SHIELD
5931700001Medicare NSC