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General NPI Number Information
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NPI Number | 1023017068
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC SURGERY PAVILION, LP
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2001 COOPER ST
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City | FORT WORTH
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State | TX
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Zip | 76104-2529
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Country | US
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Telephone | 817-877-1291
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Fax | 817-877-1292
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Provider Business Mailing Address
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Address Line | PO BOX 961094
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City | FORT WORTH
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State | TX
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Zip | 76161-0094
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Country | US
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Telephone | 817-877-1291
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Fax | 817-877-1292
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOSEPH MILNE
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Credential | M.D.
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Telephone | 817-493-2356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007075
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License Number State | TX
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