Provider Demographics
NPI:1790019255
Name:ERIC BROCK, MD, ORTHOPEDIC SURGERY, PA
Entity Type:Organization
Organization Name:ERIC BROCK, MD, ORTHOPEDIC SURGERY, PA
Other - Org Name:BROCK ORTHOPEDIC SURGERY AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-325-7900
Mailing Address - Street 1:715 W HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-4852
Mailing Address - Country:US
Mailing Address - Phone:940-325-7900
Mailing Address - Fax:940-325-7905
Practice Address - Street 1:715 W HUBBARD ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4852
Practice Address - Country:US
Practice Address - Phone:940-325-7900
Practice Address - Fax:940-325-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4311207X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6427870001OtherDME-CIGNA GOVT SERVICES
TX208673801Medicaid
TXOA5331Medicare PIN
TX6427870001Medicare NSC