| Organization Name: | NORTHEAST ORTHOPAEDICS & SPORTS MEDICINE, LLP |
| NPI Number: | 1063817260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID L. FOX (MANAGING PARTNER) |
| Mailing Address: | 12709 Toepperwein Rd Suite 101 Live Oak |
| State: | TX US |
| Postal Code: | 782333259 |
| Phone Number: | 2104775151 |
| Fax Number: | 2104775152 |
| NPI Enumeration Date: | 10/30/2014 |
| NPI Last Update Date: | 10/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |