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General NPI Number Information
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NPI Number | 1609483155
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Entity Type | Organization
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Legal Business Name | ORTHOLONESTAR, PLLC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 203 NACOGDOCHES ST STE 350
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2454
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Country | US
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Telephone | 903-939-7500
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Fax | 903-939-7728
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Provider Business Mailing Address
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Address Line | 3414 GOLDEN RD
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City | TYLER
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State | TX
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Zip | 75701-8336
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Country | US
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Telephone | 903-939-7500
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Fax | 903-939-7728
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER KINMAN
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Credential |
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Telephone | 512-439-1000
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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 |
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License Number State |
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