Provider Demographics
NPI:1821148032
Name:CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
Entity Type:Organization
Organization Name:CHISHOLM TRAIL ORTHOPEDICS & SPORTS MEDICINE, LLLP
Other - Org Name:CHISHOLM TRAIL ORTHOPEDIC & SPORTS MEDICINE, LLLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FARLESS
Authorized Official - Suffix:IX
Authorized Official - Credentials:MD
Authorized Official - Phone:817-556-3212
Mailing Address - Street 1:2010 W KATHERINE P RAINES RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7435
Mailing Address - Country:US
Mailing Address - Phone:817-556-3212
Mailing Address - Fax:817-556-2388
Practice Address - Street 1:2010 W KATHERINE P RAINES RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7435
Practice Address - Country:US
Practice Address - Phone:817-556-3212
Practice Address - Fax:817-556-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083406102Medicaid
TX1241330001Medicare NSC
TX083406101Medicaid