MEDICARE: ORTHOPEDICS TODAY

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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician		TX
2	207QS0010X	Sports Medicine (Family Medicine) Physician		TX

General Provider Information

NPI Number	:	1265862668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDICS TODAY

Provider Business Mailing Address
First Line	:	6049 S HULEN ST
Second Line	:	100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4815
Country	:	US
Telephone Number	:	817-529-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6049 S HULEN ST
Second Line	:	100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4815
Country	:	US
Telephone Number	:	817-529-1900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL BOOTHBY
Credential	:
Telephone Number	:	817-529-1900

Provider Enumeration Date	:	11/21/2013
Last Update Date	:	11/21/2013

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