MEDICARE: ORTHOPEDIC CLINIC OF GALVESTON COUNTY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200026746	OTHER	TX	RR MEDICARE
6	200000325	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125226900	OTHER	TX	DEPT OF LABOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	540189	OTHER	TX	UHC

General Provider Information

NPI Number	:	1326049370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC CLINIC OF GALVESTON COUNTY ASSOCIATES

Provider Business Mailing Address
First Line	:	6501 MEMORIAL DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4015
Country	:	US
Telephone Number	:	409-938-8161
Fax Number	:	409-938-0837

Provider Business Practice Location Address
First Line	:	6501 MEMORIAL DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4015
Country	:	US
Telephone Number	:	409-938-8161
Fax Number	:	409-938-0837

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUMMER R FRYE
Credential	:
Telephone Number	:	409-938-8161

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/11/2023

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