Provider Demographics
NPI:1538684378
Name:TEXAS ACADEMY OF SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:TEXAS ACADEMY OF SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:832-564-5030
Mailing Address - Street 1:3000 SAGE RD APT 1161
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6330
Mailing Address - Country:US
Mailing Address - Phone:832-564-5030
Mailing Address - Fax:
Practice Address - Street 1:3000 SAGE RD APT 1161
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6330
Practice Address - Country:US
Practice Address - Phone:832-564-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110828261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain