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General NPI Number Information
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NPI Number | 1407202484
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Entity Type | Organization
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Legal Business Name | SPORTSORTHO SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 610 KAIMALI DR
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City | HARLINGEN
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State | TX
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Zip | 78550-0233
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Country | US
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Telephone | 956-232-3088
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Fax | 855-594-8131
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Provider Business Mailing Address
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Address Line | PO BOX 531060
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City | HARLINGEN
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State | TX
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Zip | 78553-1060
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Country | US
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Telephone | 956-232-3088
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Fax | 855-594-8131
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KIMBERLY A LIDBOM OXFORD
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Credential |
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Telephone | 956-465-1091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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