Provider Demographics
NPI:1538104815
Name:CENTRAL TEXAS ORTHOPAEDIC CLINIC, PA
Entity Type:Organization
Organization Name:CENTRAL TEXAS ORTHOPAEDIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-526-0188
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2117 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-0188
Practice Address - Fax:254-526-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX826203342OtherMEDICARE RAILROAD
TX0048BROtherBLUE CROSS BLUE SHIELD
TX080681201Medicaid
TX0048BRMedicare PIN
TX0634700001Medicare NSC