MEDICARE: CENTER FOR ORTHOPAEDIC & SPORTS MEDICINE, P.A.

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	J3695	TX

General Provider Information

NPI Number	:	1962728865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ORTHOPAEDIC & SPORTS MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	425 HOLDERRIETH BLVD STE 208
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4552
Country	:	US
Telephone Number	:	281-357-5515
Fax Number	:	281-781-2527

Provider Business Practice Location Address
First Line	:	19701 KINGWOOD DR STE 8
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3775
Country	:	US
Telephone Number	:	281-357-5515
Fax Number	:	281-255-3440

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MICHAEL L BLACKWELL
Credential	:	MD
Telephone Number	:	281-357-5515

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	05/06/2025

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