MEDICARE: NORTHEAST TEXAS ORTHOPAEDIC SPCECIALISTS 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	174400000X	Specialist

General Provider Information

NPI Number	:	1962525477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST TEXAS ORTHOPAEDIC SPCECIALISTS PA

Provider Business Mailing Address
First Line	:	1718 S HENDERSON BLVD
Second Line	:	SUITE 4
City	:	KILGORE
State	:	TX
Zip	:	75662-3566
Country	:	US
Telephone Number	:	903-983-2556
Fax Number	:	903-983-3115

Provider Business Practice Location Address
First Line	:	1718 S HENDERSON BLVD
Second Line	:	SUITE 4
City	:	KILGORE
State	:	TX
Zip	:	75662-3566
Country	:	US
Telephone Number	:	903-983-2556
Fax Number	:	903-983-3115

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KAREN LATHAM WALDO
Credential	:
Telephone Number	:	903-983-2556

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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Directions to “NORTHEAST TEXAS ORTHOPAEDIC SPCECIALISTS PA ” Practice Location

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