Provider Demographics
NPI:1346869401
Name:RIO ORTHOPEDICS AND SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:RIO ORTHOPEDICS AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:IAGULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-969-6030
Mailing Address - Street 1:8210 MID CITIES BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:N RICHLND HLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-4701
Mailing Address - Country:US
Mailing Address - Phone:817-969-6030
Mailing Address - Fax:817-969-6039
Practice Address - Street 1:8210 MID CITIES BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:N RICHLND HLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4701
Practice Address - Country:US
Practice Address - Phone:817-969-6030
Practice Address - Fax:817-969-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty