MEDICARE: MRS. SUSAN KEITH LINDER MD

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	208100000X	Physical Medicine & Rehabilitation Physician	H8972	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	H8972	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS	OTHER	TX	00L11W

General Provider Information

NPI Number	:	1821058132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN KEITH LINDER MD

Provider Business Mailing Address
First Line	:	PO BOX 961013
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-0013
Country	:	US
Telephone Number	:	817-926-7671
Fax Number	:	817-926-7772

Provider Business Practice Location Address
First Line	:	2800 S HULEN ST
Second Line	:	SUITE 203
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1504
Country	:	US
Telephone Number	:	817-926-7671
Fax Number	:	817-926-7772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/22/2009

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