Provider Demographics
NPI:1710016894
Name:AMARILLO BONE & JOINT CLINIC
Entity Type:Organization
Organization Name:AMARILLO BONE & JOINT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BJORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-468-9700
Mailing Address - Street 1:3501 S SONCY RD STE 129
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6406
Mailing Address - Country:US
Mailing Address - Phone:806-468-9700
Mailing Address - Fax:806-468-9771
Practice Address - Street 1:3501 S SONCY RD STE 129
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6406
Practice Address - Country:US
Practice Address - Phone:806-468-9700
Practice Address - Fax:806-468-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084277501Medicaid
TX85W810OtherBCBS
TX00N69TMedicare PIN