Provider Demographics
NPI:1710182217
Name:PARKLAND MEMORIAL HOSPITAL-DEPT OF ORTHOPAEDICS
Entity Type:Organization
Organization Name:PARKLAND MEMORIAL HOSPITAL-DEPT OF ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW-ORTHOPAEDIC TRAUMA
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEFAIVRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-648-4712
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:DEPT OF ORHTO SURGERY-UTSW MED CENTER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8870
Mailing Address - Country:US
Mailing Address - Phone:214-648-4712
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:DEPT OF ORHTO SURGERY-UTSW MED CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8870
Practice Address - Country:US
Practice Address - Phone:214-648-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10028821282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital