MEDICARE: CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP

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	213E00000X	Podiatrist
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1619675873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP

Provider Business Mailing Address
First Line	:	CHISHOLM TRAIN ORTHOPEDICS&SPORTS MEDICINE,LLLP
Second Line	:	2010 W KATHERINE P RAINES RD SUITE 300
City	:	CLEBURNE
State	:	TX
Zip	:	76033-7447
Country	:	US
Telephone Number	:	817-556-3212
Fax Number	:	817-556-2388

Provider Business Practice Location Address
First Line	:	5540 SYCAMORE SCHOOL RD
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76123
Country	:	US
Telephone Number	:	817-556-3212
Fax Number	:	817-556-2388

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TRACEY R MORGAN
Credential	:	OFFICE MANAGER
Telephone Number	:	817-556-3212

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	03/16/2023

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