Provider Demographics
NPI:1689633430
Name:FORT WORTH ORTHOPEDIC SURGERY & SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:FORT WORTH ORTHOPEDIC SURGERY & SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-737-8880
Mailing Address - Street 1:3625 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3351
Mailing Address - Country:US
Mailing Address - Phone:817-737-8880
Mailing Address - Fax:817-731-9112
Practice Address - Street 1:3625 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3351
Practice Address - Country:US
Practice Address - Phone:817-737-8880
Practice Address - Fax:817-731-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4102207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2000022563Medicaid
TX0538180001Medicare NSC
TX00T22KMedicare PIN