Provider Demographics
NPI:1790235083
Name:TOTAL TRAUMA CARE, PLLC
Entity Type:Organization
Organization Name:TOTAL TRAUMA CARE, PLLC
Other - Org Name:ADVENT ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/LEGAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-624-6882
Mailing Address - Street 1:3500 HILLCREST DR
Mailing Address - Street 2:STE 1
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3144
Mailing Address - Country:US
Mailing Address - Phone:888-624-6882
Mailing Address - Fax:888-882-4498
Practice Address - Street 1:9200 PINECROFT DR STE 280
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3281
Practice Address - Country:US
Practice Address - Phone:888-624-6882
Practice Address - Fax:888-882-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338817501Medicaid