Healthcare Provider Details

I. General information

NPI: 1871784652
Provider Name (Legal Business Name): AMARILLO BONE & JOINT CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

IV. Provider business mailing address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

V. Phone/Fax

Practice location:
  • Phone: 806-468-9700
  • Fax: 806-468-9771
Mailing address:
  • Phone: 806-468-9700
  • Fax: 806-468-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. JENNIFER RICHEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 806-468-9700