Provider Demographics
NPI:1922338573
Name:THOMAS M. CARRELL, MD, PA
Entity Type:Organization
Organization Name:THOMAS M. CARRELL, MD, PA
Other - Org Name:MIDCITIES ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-595-0508
Mailing Address - Street 1:4375 BOOTH CALLOWAY RD
Mailing Address - Street 2:STE 410
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8365
Mailing Address - Country:US
Mailing Address - Phone:817-595-0508
Mailing Address - Fax:817-284-0667
Practice Address - Street 1:4375 BOOTH CALLOWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8365
Practice Address - Country:US
Practice Address - Phone:817-595-0508
Practice Address - Fax:817-284-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5974Medicare PIN