Provider Demographics
NPI:1558502773
Name:THADDEUS OPALACH DO PA
Entity Type:Organization
Organization Name:THADDEUS OPALACH DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:OPALACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-453-2223
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 1:990 N WALNUT CREEK DR
Practice Address - Street 2:SUITE 2014
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1580
Practice Address - Country:US
Practice Address - Phone:817-453-2223
Practice Address - Fax:817-453-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL88702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty