Provider Demographics
NPI:1659303618
Name:ORTHOPEDIC SPECIALTY ASSOCIATES PA
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALTY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-878-5444
Mailing Address - Street 1:800 5TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-878-5300
Mailing Address - Fax:817-878-5300
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-878-5300
Practice Address - Fax:817-878-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083501901Medicaid
TX0528570001Medicare NSC
TX00K48DMedicare PIN