Provider Demographics
NPI:1831143353
Name:WEST TEXAS ORTHOPEDICS LLP
Entity Type:Organization
Organization Name:WEST TEXAS ORTHOPEDICS LLP
Other - Org Name:WEST TEXAS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:432-520-3020
Mailing Address - Street 1:PO BOX 5556
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5556
Mailing Address - Country:US
Mailing Address - Phone:432-520-3020
Mailing Address - Fax:432-699-1981
Practice Address - Street 1:4304 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4824
Practice Address - Country:US
Practice Address - Phone:432-520-3020
Practice Address - Fax:432-699-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDN1249OtherMEDICARE RAILROAD
TX0049PDOtherBCBS GROUP #
TX191095201Medicaid
TXDN1249OtherMEDICARE RAILROAD
TX00X426Medicare Oscar/Certification