Healthcare Provider Details

I. General information

NPI: 1164672374
Provider Name (Legal Business Name): FONDREN ORTHOPEDIC GROUP L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BELLFORT AVE STE 150
HOUSTON TX
77054-5099
US

IV. Provider business mailing address

7401 MAIN ST
HOUSTON TX
77030-4509
US

V. Phone/Fax

Practice location:
  • Phone: 713-349-9335
  • Fax: 713-349-8433
Mailing address:
  • Phone: 713-799-2300
  • Fax: 713-794-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number179
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number179
License Number StateTX

VIII. Authorized Official

Name: KAREN YATES
Title or Position: COO
Credential:
Phone: 713-794-3339