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General NPI Number Information
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NPI Number | 1548687098
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Entity Type | Organization
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Legal Business Name | ORTHOVAN
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Dates
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Enumeration Date | 03/22/2014
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Last Update Date | 03/22/2014
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Provider Practice Location Address
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Address Line | 3009 E RENNER RD
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City | RICHARDSON
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State | TX
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Zip | 75082-3571
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Country | US
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Telephone | 972-661-0606
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Fax | 970-661-0808
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Provider Business Mailing Address
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Address Line | PO BOX 941311
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City | PLANO
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State | TX
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Zip | 75094-1311
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Country | US
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Telephone | 972-661-0606
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Fax | 972-661-0808
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRY MADSEN
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Credential | M.D.
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Telephone | 972-661-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | L8816
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License Number State | TX
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