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Organization

SPORTSORTHO SURGERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY A LIDBOM OXFORD (BILLING MANAGER)
(956) 465-1091
Entity
Organization

Contact information

Practice address
610 KAIMALI DR, HARLINGEN, TX 78550-0233
(956) 232-3088
(855) 594-8131
Mailing address
PO BOX 531060, HARLINGEN, TX 78553-1060
(956) 232-3088
(855) 594-8131

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
130384
STATE LICENSE
TX
05
391353501
TX
01
45D2145076
CLIA ID NUMBER
TX
Enumeration date
05/10/2016
Last updated
06/12/2025
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