MEDICARE: ORTHO SPINE SURGERY INSTITUTE PA

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	L4093	TX

General Provider Information

NPI Number	:	1386861698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO SPINE SURGERY INSTITUTE PA

Provider Business Mailing Address
First Line	:	8801 N TARRANT PKWY
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8461
Country	:	US
Telephone Number	:	817-616-0700
Fax Number	:	817-616-0708

Provider Business Practice Location Address
First Line	:	8801 N TARRANT PKWY
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8461
Country	:	US
Telephone Number	:	817-616-0700
Fax Number	:	817-616-0708

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFF PHELPS
Credential	:	MD
Telephone Number	:	817-616-0700

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	10/03/2011

Similar Medicare Providers

1053365304 — MR. JEFFREY B PHELPS M.D.
Practice Location Address:

8801 N TARRANT PKWY
NORTH RICHLAND HILLS, TX
76182-8461

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Practice Fax: 817-616-0708

1104007178 — DR. JOSHUA C. HAY MD
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NORTH RICHLAND HILLS, TX
76182-8461

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1669813523 — SPINE WORKS SURGICAL ASSOCIATES
Practice Location Address:

8801 N TARRANT PKWY
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76182-8461

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1821407685 — SPINE WORKS MANAGEMENT, PLLC
Practice Location Address:

8801 N TARRANT PKWY
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1316322373 — KAJT, PLLC
Practice Location Address:

8801 N TARRANT PKWY
NORTH RICHLAND HILLS, TX
76182-8461

Practice Phone: 817-616-0700
Practice Fax: 817-616-0708

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