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General NPI Number Information
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NPI Number | 1093088684
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Entity Type | Organization
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Legal Business Name | JOHN PETER SMITH HOSPITAL ORTHOPEDICS
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-927-1321
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | RUSSELL WAGNER
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Credential |
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Telephone | 817-927-1370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | P1268
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License Number State | TX
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