Provider Demographics
NPI:1285658831
Name:TEXAS ORTHOPAEDIC & SPORTS MEDICINE
Entity type:Organization
Organization Name:TEXAS ORTHOPAEDIC & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-803-3246
Mailing Address - Street 1:13603 MICHEL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6410
Mailing Address - Country:US
Mailing Address - Phone:281-351-7261
Mailing Address - Fax:281-351-2515
Practice Address - Street 1:13603 MICHEL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6410
Practice Address - Country:US
Practice Address - Phone:281-351-7261
Practice Address - Fax:281-351-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U78ZOtherMEDICARE PTAN
TX0995950001OtherMEDICARE DME TOMBALL
TX0995950002OtherMEDICARE DME THE WOODLANDS