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General NPI Number Information
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NPI Number | 1396561486
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Entity Type | Organization
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Legal Business Name | RENEW ORTHOPEDIC CENTER
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Dates
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Enumeration Date | 11/23/2024
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 105 OLD HEWITT RD STE 300
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City | WACO
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State | TX
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Zip | 76712-6565
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Country | US
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Telephone | 254-309-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 105 OLD HEWITT RD STE 300
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City | WACO
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State | TX
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Zip | 76712-6565
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Country | US
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Telephone | 254-309-2288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER MIARS
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Credential | DO
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Telephone | 254-309-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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