MEDICARE: CENTRAL TEXAS ORTHOPEDIC SURGERY,P.A.

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	J6662	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0040AV	OTHER	TX	BLUE CROSS BLUE SHIELD TX
2	119756	OTHER	TX	SUPERIOR HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	181622100	OTHER	TX	DEPT OF LABOR
5	8X1180	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1619078920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TEXAS ORTHOPEDIC SURGERY,P.A.

Provider Business Mailing Address
First Line	:	2510 CROCKETT DR
Second Line	:	SUITE A
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5928
Country	:	US
Telephone Number	:	325-643-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 CROCKETT DR
Second Line	:	SUITE A
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5928
Country	:	US
Telephone Number	:	325-643-5513
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CRESCENT L CLARK
Credential	:
Telephone Number	:	325-643-5513

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/22/2008

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Directions to “CENTRAL TEXAS ORTHOPEDIC SURGERY,P.A. ” Practice Location

Language	Start Address	Practice Location

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