Provider Demographics
NPI:1568618619
Name:MAYME RICHIE-GILLESPIE, M.D., P.A.
Entity Type:Organization
Organization Name:MAYME RICHIE-GILLESPIE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHIE-GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-688-0920
Mailing Address - Street 1:PO BOX 26979
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0979
Mailing Address - Country:US
Mailing Address - Phone:817-702-9100
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7300
Practice Address - Country:US
Practice Address - Phone:817-735-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2723207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z700Medicare PIN