MEDICARE: CY-FAIR BONE & JOINT LLP

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	K6574	TX
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	M0651	TX
3	207X00000X	Orthopaedic Surgery Physician	N2496	TX
4	2080S0010X	Pediatric Sports Medicine Physician	N6827	TX
5	207X00000X	Orthopaedic Surgery Physician	P6096	TX
6	207XS0106X	Orthopaedic Hand Surgery Physician	Q1860	TX
7	207PS0010X	Sports Medicine (Emergency Medicine) Physician	Q6465	TX
8	111N00000X	Chiropractor	12013	TX
9	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	N8571	TX
10	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	J0085	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0046HD	OTHER	TX	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1972556660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CY-FAIR BONE & JOINT LLP

Provider Business Mailing Address
First Line	:	11800 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3840
Country	:	US
Telephone Number	:	281-664-2107
Fax Number	:	281-955-5875

Provider Business Practice Location Address
First Line	:	11800 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3840
Country	:	US
Telephone Number	:	281-664-2107
Fax Number	:	281-955-5875

Authorized Official
Title or Position	:	MD/MANAGING PARTNER
Name	:	DR. DAVID MACK
Credential	:	MD
Telephone Number	:	281-664-2107

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/09/2017

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Directions to “CY-FAIR BONE & JOINT LLP ” Practice Location

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