Provider Demographics
NPI:1942905922
Name:LAS COLINAS ORTHOPEDIC SURGERY AND SPORTS MEDICINE P.A.
Entity Type:Organization
Organization Name:LAS COLINAS ORTHOPEDIC SURGERY AND SPORTS MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-637-8960
Mailing Address - Street 1:400 W LBJ FWY STE 330
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3717
Mailing Address - Country:US
Mailing Address - Phone:972-556-2885
Mailing Address - Fax:972-506-8733
Practice Address - Street 1:3124 N TARRANT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8618
Practice Address - Country:US
Practice Address - Phone:972-556-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAS COLINAS ORTHOPEDIC SURGERY AND SPORTS MEDICINE P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty