Provider Demographics
NPI:1396561486
Name:RENEW ORTHOPEDIC CENTER
Entity type:Organization
Organization Name:RENEW ORTHOPEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIARS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-309-2244
Mailing Address - Street 1:105 OLD HEWITT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6565
Mailing Address - Country:US
Mailing Address - Phone:254-309-2288
Mailing Address - Fax:
Practice Address - Street 1:105 OLD HEWITT RD STE 300
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6565
Practice Address - Country:US
Practice Address - Phone:254-309-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty