Provider Demographics
NPI:1316135304
Name:THE ORTHOPAEDICS CENTER LLC
Entity type:Organization
Organization Name:THE ORTHOPAEDICS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-731-9300
Mailing Address - Street 1:305 E LACY STE 120
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-731-9300
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:COMPLEX 5 STE 4
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-392-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42629241Medicaid
NM=========OtherTAX ID