Provider Demographics
NPI:1932695681
Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS ORTHOPEDIC SPINE ARLINGTON LLLP
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS ORTHOPEDIC SPINE ARLINGTON LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-513-8619
Mailing Address - Street 1:PO BOX 96283
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0128
Mailing Address - Country:US
Mailing Address - Phone:817-994-5908
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHLANDER BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4319
Practice Address - Country:US
Practice Address - Phone:817-583-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty