Provider Demographics
NPI:1619675873
Name:CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
Entity Type:Organization
Organization Name:CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:817-556-3212
Mailing Address - Street 1:CHISHOLM TRAIN ORTHOPEDICS&SPORTS MEDICINE,LLLP
Mailing Address - Street 2:2010 W KATHERINE P RAINES RD SUITE 300
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7447
Mailing Address - Country:US
Mailing Address - Phone:817-556-3212
Mailing Address - Fax:817-556-2388
Practice Address - Street 1:5540 SYCAMORE SCHOOL RD
Practice Address - Street 2:SUITE 312
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123
Practice Address - Country:US
Practice Address - Phone:817-556-3212
Practice Address - Fax:817-556-2388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty