=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952360745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR ORTHOPAEDIC SPECIALTIES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2006
-----------------------------------------------------
Last Update Date | 04/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 UNIVERSITY DR E SUITE 255
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-3475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-774-0411
-----------------------------------------------------
Fax | 979-776-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 UNIVERSITY DR E SUITE 255
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-3475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-774-0411
-----------------------------------------------------
Fax | 979-776-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | DAWN D SUEHS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 979-774-0411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------