Provider Demographics
NPI:1790795870
Name:REGIONAL ORTHOPAEDIC AND SPORTS MEDICINE CENTER, P.A.
Entity Type:Organization
Organization Name:REGIONAL ORTHOPAEDIC AND SPORTS MEDICINE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-937-8900
Mailing Address - Street 1:1324 BROWN ST
Mailing Address - Street 2:STE100
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-937-8900
Mailing Address - Fax:972-937-7936
Practice Address - Street 1:1324 BROWN ST
Practice Address - Street 2:STE100
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1421
Practice Address - Country:US
Practice Address - Phone:972-937-8900
Practice Address - Fax:972-937-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4626890001Medicare NSC