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General NPI Number Information
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NPI Number | 1619675873
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Entity Type | Organization
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Legal Business Name | CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 5540 SYCAMORE SCHOOL RD SUITE 312
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City | FORT WORTH
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State | TX
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Zip | 76123
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Country | US
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Telephone | 817-556-3212
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Fax | 817-556-2388
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Provider Business Mailing Address
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Address Line | CHISHOLM TRAIN ORTHOPEDICS&SPORTS MEDICINE,LLLP 2010 W KATHERINE P RAINES RD SUITE 300
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City | CLEBURNE
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State | TX
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Zip | 76033-7447
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Country | US
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Telephone | 817-556-3212
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Fax | 817-556-2388
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACEY R MORGAN
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Credential | OFFICE MANAGER
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Telephone | 817-556-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 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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