Provider Demographics
NPI:1124424171
Name:ADVANCED ORTHOPAEDICS & SPORTS MEDICINE
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-955-7577
Mailing Address - Street 1:11800 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22485 TOMBALL PKWY
Practice Address - Street 2:SUITE 2100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1551
Practice Address - Country:US
Practice Address - Phone:281-955-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CY-FAIR BONE & JOINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty