Healthcare Provider Details

I. General information

NPI: 1538257621
Provider Name (Legal Business Name): PRECISION ORTHOPEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2225
US

IV. Provider business mailing address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2225
US

V. Phone/Fax

Practice location:
  • Phone: 972-438-4636
  • Fax: 972-438-6585
Mailing address:
  • Phone: 972-438-4636
  • Fax: 972-438-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELYNN FANNING
Title or Position: OFFICE MANAGER
Credential:
Phone: 972-438-4636