Provider Demographics
NPI:1851652457
Name:PREMIER ORTHOPEDICS OF FORT WORTH
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDICS OF FORT WORTH
Other - Org Name:KRAIG R PEPPER DO PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:817-632-0020
Mailing Address - Street 1:6930 HARRIS PARKWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-632-0020
Mailing Address - Fax:817-632-0022
Practice Address - Street 1:6930 HARRIS PARKWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-632-0020
Practice Address - Fax:817-632-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308841101Medicaid
TX203808502Medicaid