Provider Demographics
NPI:1275652679
Name:MEMORIAL BONE & JOINT CLINIC LLP
Entity type:Organization
Organization Name:MEMORIAL BONE & JOINT CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-956-7846
Mailing Address - Street 1:4710 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2204
Mailing Address - Country:US
Mailing Address - Phone:866-956-7846
Mailing Address - Fax:713-691-9803
Practice Address - Street 1:4710 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2204
Practice Address - Country:US
Practice Address - Phone:866-956-7846
Practice Address - Fax:713-691-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00785VMedicare PIN