Healthcare Provider Details

I. General information

NPI: 1346514833
Provider Name (Legal Business Name): TEXOMA ORTHOPEDIC AND SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 S US HIGHWAY 75 SUITE 120
DENISON TX
75020-4587
US

IV. Provider business mailing address

5012 S US HIGHWAY 75 SUITE 120
DENISON TX
75020-4587
US

V. Phone/Fax

Practice location:
  • Phone: 903-465-2190
  • Fax: 903-465-2262
Mailing address:
  • Phone: 903-465-2190
  • Fax: 903-465-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLYE KEITZ
Title or Position: BACK OFFICE MANAGER
Credential:
Phone: 903-465-2190