MEDICARE: RELIANCE ORTHOPEDIC AND SPORTS MEDICINE PLLC

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

General Provider Information

NPI Number	:	1790168060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANCE ORTHOPEDIC AND SPORTS MEDICINE PLLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-5447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8601
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHLEEN KONDAS
Credential	:
Telephone Number	:	317-614-9871

Provider Enumeration Date	:	07/06/2015
Last Update Date	:	04/20/2021

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