Provider Demographics
NPI:1023017068
Name:ORTHOPEDIC SURGERY PAVILION, LP
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY PAVILION, LP
Other - Org Name:ORTHOPEDIC SURGERY PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-493-2356
Mailing Address - Street 1:PO BOX 961094
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0094
Mailing Address - Country:US
Mailing Address - Phone:817-877-1291
Mailing Address - Fax:817-877-1292
Practice Address - Street 1:2001 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2529
Practice Address - Country:US
Practice Address - Phone:817-877-1291
Practice Address - Fax:817-877-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007075261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRRMCHCX12OtherRAILROAD MEDICARE
TX60054OtherAETNA
TX75261OtherPHCS
TXHH1507OtherBLUE CROSS BUE SHIELD
TX60054OtherAETNA