MEDICARE: TEXAS ORTHOPAEDIC ASSOCIATES, LLP

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	207X00000X	Orthopaedic Surgery Physician
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1407355621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ORTHOPAEDIC ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	8210 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4405
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	8081 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4313
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MICHAEL JAMES CHAMPINE
Credential	:	MD
Telephone Number	:	972-616-4000

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	02/02/2018

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