Provider Demographics
NPI:1477313757
Name:PRECISION ORTHOPEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:PRECISION ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-438-4636
Mailing Address - Street 1:2120 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2260
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:
Practice Address - Street 1:245 W STATE HIGHWAY 114 STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3640
Practice Address - Country:US
Practice Address - Phone:682-477-4290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies