Provider Demographics
NPI:1346514833
Name:TEXOMA ORTHOPEDIC AND SPINE PLLC
Entity Type:Organization
Organization Name:TEXOMA ORTHOPEDIC AND SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BACK OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLYE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-465-2190
Mailing Address - Street 1:5012 S US HIGHWAY 75
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:903-465-2190
Mailing Address - Fax:903-465-2262
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 120
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-465-2190
Practice Address - Fax:903-465-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty