=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366273716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC INSTITUTE OF NORTH TEXAS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2024
-----------------------------------------------------
Last Update Date | 08/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2560 CENTRAL PARK AVE STE 395
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-591-6468
-----------------------------------------------------
Fax | 972-294-3343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 207674
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-7674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-591-6468
-----------------------------------------------------
Fax | 972-294-3343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUSTIN KANE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-591-6468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------