MEDICARE: ORTHO KINETICS, LTD

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	332B00000X	Durable Medical Equipment & Medical Supplies	0091478	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0091478	OTHER	TX	MED DEVICE DISTRIBUTOR

General Provider Information

NPI Number	:	1972686814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO KINETICS, LTD

Provider Business Mailing Address
First Line	:	7301 FANNIN ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4807
Country	:	US
Telephone Number	:	713-797-0011
Fax Number	:	713-797-0010

Provider Business Practice Location Address
First Line	:	11201 RICHMOND AVE # A106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-6653
Country	:	US
Telephone Number	:	713-983-7324
Fax Number	:	713-983-7928

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KEVIN D HOLYFIELD
Credential	:
Telephone Number	:	713-660-8801

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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Directions to “ORTHO KINETICS, LTD ” Practice Location

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