SPORTSORTHO SURGERY CENTER LLC NPI 1407202484

NPI Information

NPI: 1407202484
Provider Name: SPORTSORTHO SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 45D2145076

Address:
610 KAIMALI DR
HARLINGEN, TX
ZIP 78550
Phone: (956) 371-2243
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SPORTSORTHO SURGERY CENTER LLC is an ambulatory surgical clinic center in Harlingen, TX. SPORTSORTHO SURGERY CENTER LLC NPI is 1407202484. The provider is registered as an organization entity type.

The provider's business location address is:

610 KAIMALI DR
HARLINGEN, TX
ZIP 78550-233
Phone: (956) 371-2243
Fax: (855) 594-8131

The provider's authorized official is Kim Lidbom .
The authorized official title is Billing And Credentialing and has the following contact phone number (956) 465-1091.

The CLIA number assigned to this NPI record is 45D2145076 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/10/2016 and was last updated on 1/23/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	391353501	MEDICAID	TEXAS
2	45D2145076	OTHER	TEXAS	CLIA ID NUMBER
3	130384	OTHER	TEXAS	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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