Provider Demographics
NPI:1467145961
Name:TMI SPORTS MEDICINE AND ORTHOPEDIC SURGERY PA
Entity Type:Organization
Organization Name:TMI SPORTS MEDICINE AND ORTHOPEDIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEELDREYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-419-0303
Mailing Address - Street 1:3533 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3604
Mailing Address - Country:US
Mailing Address - Phone:817-419-0303
Mailing Address - Fax:833-626-1951
Practice Address - Street 1:11000 FRISCO ST STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-2033
Practice Address - Country:US
Practice Address - Phone:817-419-0303
Practice Address - Fax:833-626-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2S9727OtherMEDICARE PTAN
TX193200000XOtherTAXONOMY