MEDICARE: ORTHOLONESTAR, PLLC

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

General Provider Information

NPI Number	:	1295321958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOLONESTAR, PLLC

Provider Business Mailing Address
First Line	:	8210 WALNUT HILL LN STE 130
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-750-8504

Provider Business Practice Location Address
First Line	:	5701 BRYANT IRVIN RD STE 302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4027
Country	:	US
Telephone Number	:	817-854-9969
Fax Number	:	817-854-9965

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER KINMAN
Credential	:
Telephone Number	:	512-439-1000

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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