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NPI Code Detail

MEDICARE: ORTHOLONESTAR, PLLC

MEDICARE: ORTHOLONESTAR, PLLC
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
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1336756980
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOLONESTAR, PLLC
Provider Business Mailing Address
First Line : 3414 GOLDEN RD
Second Line :
City : TYLER
State : TX
Zip : 75701-8336
Country : US
Telephone Number : 903-939-7500
Fax Number : 903-939-7728
Provider Business Practice Location Address
First Line : 3816 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2011
Country : US
Telephone Number : 903-939-7500
Fax Number : 903-939-7728
Authorized Official
Title or Position : COO
Name : ADAM MAURER
Credential :
Telephone Number : 713-794-3352
Provider Enumeration Date : 09/28/2020
Last Update Date : 01/03/2022

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Directions to “ORTHOLONESTAR, PLLC ” Practice Location

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