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General NPI Number Information
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NPI Number | 1194781773
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL TEXAS ORTHOPAEDICS AND SPORTS MEDICINE PA
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 2800 E TX HIGHWAY 114 STE 130
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City | TROPHY CLUB
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State | TX
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Zip | 76262-5305
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Country | US
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Telephone | 469-916-4435
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Fax | 855-959-1785
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Provider Business Mailing Address
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Address Line | 2800 E TX HWY 114 STE 130
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City | TROPHY CLUB
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State | TX
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Zip | 76262
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Country | US
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Telephone | 469-916-4435
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Fax | 855-959-1785
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Authorized Official
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Title or Position | DO
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Name | RANDALL MCKENNA
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Credential | DO
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Telephone | 940-627-3491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | M6477
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1305
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | J0118
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | K7089
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | J0118
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License Number State | TX
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