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General NPI Number Information
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NPI Number | 1811375645
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Entity Type | Organization
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Legal Business Name | LEAN 3, LLC
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 4420 HERITAGE TRACE PKWY STE 308
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City | FORT WORTH
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State | TX
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Zip | 76244-8903
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Country | US
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Telephone | 817-717-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 HERITAGE TRACE PKWY STE 308
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City | FORT WORTH
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State | TX
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Zip | 76244-8903
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Country | US
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Telephone | 817-717-5100
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | JASON TINLEY
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Credential | MD
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Telephone | 817-717-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | M7690
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License Number State | TX
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