Healthcare Provider Details

I. General information

NPI: 1851652457
Provider Name (Legal Business Name): PREMIER ORTHOPEDICS OF FORT WORTH, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 HARRIS PKWY STE 130
FORT WORTH TX
76132-4272
US

IV. Provider business mailing address

6930 HARRIS PARKWAY SUITE 130
FORT WORTH TX
76132
US

V. Phone/Fax

Practice location:
  • Phone: 817-632-0020
  • Fax: 817-632-0022
Mailing address:
  • Phone: 817-632-0020
  • Fax: 817-632-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SONJA MANNING
Title or Position: MEDICAL OFFICE SUPPORT
Credential:
Phone: 817-632-0020