Provider Demographics
NPI: | 1033407317 |
---|---|
Name: | REPUBLIC ORTHOPEDICS PLLC |
Entity Type: | Organization |
Organization Name: | REPUBLIC ORTHOPEDICS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LLOYD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 214-261-3600 |
Mailing Address - Street 1: | 10740 N CENTRAL EXPY |
Mailing Address - Street 2: | SUITE 275 |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75231-2161 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-261-3600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10740 N CENTRAL EXPY |
Practice Address - Street 2: | SUITE 275 |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75231-2161 |
Practice Address - Country: | US |
Practice Address - Phone: | 214-261-3600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LONESTAR MULTICARE PLLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2011-07-20 |
Last Update Date: | 2011-07-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Single Specialty |