Provider Demographics
NPI:1154346971
Name:ATHLETIC ORTHOPEDIC & KNEE CENTER
Entity type:Organization
Organization Name:ATHLETIC ORTHOPEDIC & KNEE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-984-1400
Mailing Address - Street 1:9180 OLD KATY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7454
Mailing Address - Country:US
Mailing Address - Phone:713-984-1400
Mailing Address - Fax:713-647-8090
Practice Address - Street 1:9180 OLD KATY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7454
Practice Address - Country:US
Practice Address - Phone:713-984-1400
Practice Address - Fax:713-647-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID
TX=========OtherTAX ID