MEDICARE: THOMAS M. CARRELL, MD, PA

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	:	1922338573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS M. CARRELL, MD, PA

Provider Business Mailing Address
First Line	:	4375 BOOTH CALLOWAY RD
Second Line	:	STE 410
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8365
Country	:	US
Telephone Number	:	817-595-0508
Fax Number	:	817-284-0667

Provider Business Practice Location Address
First Line	:	4375 BOOTH CALLOWAY RD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8365
Country	:	US
Telephone Number	:	817-595-0508
Fax Number	:	817-284-0667

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. THOMAS M CARRELL
Credential	:	MD
Telephone Number	:	817-595-0508

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	03/15/2012

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