Provider Demographics
NPI:1477178374
Name:TRINITY SPINE AND ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:TRINITY SPINE AND ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KJELDGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-283-5252
Mailing Address - Street 1:4444 HERITAGE TRACE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-283-5252
Mailing Address - Fax:817-283-5283
Practice Address - Street 1:4444 HERITAGE TRACE
Practice Address - Street 2:SUITE 408
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-283-5252
Practice Address - Fax:817-283-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3398OtherTEXAS MEDICAL LICENSE