Provider Demographics
NPI:1962572602
Name:THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARSTON
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:936-539-2663
Mailing Address - Street 1:1501 RIVER POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2656
Mailing Address - Country:US
Mailing Address - Phone:936-539-2663
Mailing Address - Fax:936-539-2664
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-539-2663
Practice Address - Fax:936-539-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty