Provider Demographics
NPI:1699809335
Name:TEXAS ARTHROSCOPIC SURGERY CLINIC
Entity Type:Organization
Organization Name:TEXAS ARTHROSCOPIC SURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-5633
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-336-5633
Mailing Address - Fax:817-870-9760
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-336-5633
Practice Address - Fax:817-870-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54519OtherMEDICARE RR
TX0063HTOtherBCBS
TX162093201Medicaid
TX00456VMedicare PIN