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NPI Code Detail

MEDICARE: ORTHOPEDIC SURGERY PAVILION, LP

MEDICARE: ORTHOPEDIC SURGERY PAVILION, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center007075TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RRMCHCX12OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
260054OTHERTXAETNA
375261OTHERTXPHCS
4HH1507OTHERTXBLUE CROSS BUE SHIELD

General Provider Information

NPI Number : 1023017068
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPEDIC SURGERY PAVILION, LP
Provider Business Mailing Address
First Line : PO BOX 961094
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-0094
Country : US
Telephone Number : 817-877-1291
Fax Number : 817-877-1292
Provider Business Practice Location Address
First Line : 2001 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2529
Country : US
Telephone Number : 817-877-1291
Fax Number : 817-877-1292
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. JOSEPH MILNE
Credential : M.D.
Telephone Number : 817-493-2356
Provider Enumeration Date : 07/20/2005
Last Update Date : 08/22/2020

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Directions to “ORTHOPEDIC SURGERY PAVILION, LP ” Practice Location

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