MEDICARE: ORTHOPEDIC ASSOCIATES OF DALLAS, LLP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
3	207XS0117X	Orthopaedic Surgery of the Spine Physician
4	207XX0801X	Orthopaedic Trauma Physician
5	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00K730	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1548474620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC ASSOCIATES OF DALLAS, LLP

Provider Business Mailing Address
First Line	:	PO BOX 650500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0500
Country	:	US
Telephone Number	:	214-369-8555
Fax Number	:	214-369-2683

Provider Business Practice Location Address
First Line	:	11613 N CENTRAL EXPY
Second Line	:	SUITE 108
City	:	DALLAS
State	:	TX
Zip	:	75243-3820
Country	:	US
Telephone Number	:	214-987-1622
Fax Number	:	214-987-1631

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TRACY JACKSON
Credential	:
Telephone Number	:	214-823-7090

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/08/2008

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Directions to “ORTHOPEDIC ASSOCIATES OF DALLAS, LLP ” Practice Location

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