Provider Demographics
NPI:1083945414
Name:OSTEOPODS, PLLC
Entity Type:Organization
Organization Name:OSTEOPODS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:817-313-4616
Mailing Address - Street 1:PO BOX 100937
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0937
Mailing Address - Country:US
Mailing Address - Phone:817-313-4616
Mailing Address - Fax:817-333-0173
Practice Address - Street 1:800 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4611
Practice Address - Country:US
Practice Address - Phone:817-313-4616
Practice Address - Fax:817-333-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103596Medicare PIN