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General NPI Number Information
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NPI Number | 1962525477
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Entity Type | Organization
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Legal Business Name | NORTHEAST TEXAS ORTHOPAEDIC SPCECIALISTS PA
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1718 S HENDERSON BLVD SUITE 4
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City | KILGORE
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State | TX
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Zip | 75662-3566
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Country | US
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Telephone | 903-983-2556
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Fax | 903-983-3115
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Provider Business Mailing Address
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Address Line | 1718 S HENDERSON BLVD SUITE 4
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City | KILGORE
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State | TX
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Zip | 75662-3566
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Country | US
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Telephone | 903-983-2556
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Fax | 903-983-3115
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN LATHAM WALDO
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Credential |
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Telephone | 903-983-2556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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