Provider Demographics
NPI:1518933241
Name:OAK CLIFF ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:OAK CLIFF ORTHOPAEDIC ASSOCIATES
Other - Org Name:TEXAS ORTHOPAEDIC SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-941-4243
Mailing Address - Street 1:810 N ZANG BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4233
Mailing Address - Country:US
Mailing Address - Phone:214-941-4243
Mailing Address - Fax:214-941-1153
Practice Address - Street 1:810 N ZANG BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4233
Practice Address - Country:US
Practice Address - Phone:214-941-4243
Practice Address - Fax:214-941-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166874101Medicaid
TX0569190001Medicare NSC
TX00L602Medicare ID - Type Unspecified