MEDICARE: MEDICAL CENTER ORTHOPAEDICS PA

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	207X00000X	Orthopaedic Surgery Physician	E1094	TX

General Provider Information

NPI Number	:	1417066655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER ORTHOPAEDICS PA

Provider Business Mailing Address
First Line	:	9512 MAJESTIC OAK CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3449
Country	:	US
Telephone Number	:	210-698-0607
Fax Number	:	210-614-7745

Provider Business Practice Location Address
First Line	:	9512 MAJESTIC OAK CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3449
Country	:	US
Telephone Number	:	210-698-0607
Fax Number	:	210-614-7745

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRED H OLIN
Credential	:	M.D.
Telephone Number	:	210-698-0607

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/01/2007

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