MEDICARE: ORTHOPEDIC INSTITUTE OF NORTH TEXAS, PA

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
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1366273716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC INSTITUTE OF NORTH TEXAS, PA

Provider Business Mailing Address
First Line	:	PO BOX 207674
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7674
Country	:	US
Telephone Number	:	972-591-6468
Fax Number	:	972-294-3343

Provider Business Practice Location Address
First Line	:	2560 CENTRAL PARK AVE STE 395
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1566
Country	:	US
Telephone Number	:	972-591-6468
Fax Number	:	972-294-3343

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN KANE
Credential	:	MD
Telephone Number	:	972-591-6468

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/16/2024

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