Provider Demographics
NPI:1477562726
Name:DOGWOOD ORTHOPAEDIC CLINIC, PA
Entity Type:Organization
Organization Name:DOGWOOD ORTHOPAEDIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SESSIONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-657-1441
Mailing Address - Street 1:612 N HIGH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-5914
Mailing Address - Country:US
Mailing Address - Phone:903-657-1441
Mailing Address - Fax:903-657-5886
Practice Address - Street 1:612 N HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5914
Practice Address - Country:US
Practice Address - Phone:903-657-1441
Practice Address - Fax:903-657-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5595174400000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085769002OtherMEDICAID DME
TX085769001Medicaid
TX0535550001Medicare NSC
TX085769002OtherMEDICAID DME
TXB26360Medicare UPIN
TX085769001Medicaid