Healthcare Provider Details

I. General information

NPI: 1205233269
Provider Name (Legal Business Name): AMARILLO BONE & JOINT CLINIC, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
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 TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number137052
License Number StateTX

VIII. Authorized Official

Name: ASHLEY NICOLE WHITLEY
Title or Position: CERTIFIED SURGICAL TECHNOLOGIST
Credential: CST
Phone: 806-468-9700