1154506640 NPI number — TEXAS HIP & KNEE SURGERY PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154506640 NPI number — TEXAS HIP & KNEE SURGERY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HIP & KNEE SURGERY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154506640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4222 TRINITY MILLS RD
Provider Second Line Business Mailing Address:
SUITE 252
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-7603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-239-4500
Provider Business Mailing Address Fax Number:
214-239-4504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5575 WARREN PKWY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-377-6600
Provider Business Practice Location Address Fax Number:
972-377-6614
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOPKINS
Authorized Official First Name:
ELDON
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-377-6600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X , with the licence number: L0276 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0075QU . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: L0276 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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