Provider Demographics
NPI:1972765832
Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE OF TEXAS, P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GARNER
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-265-5050
Mailing Address - Street 1:4129 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6745
Mailing Address - Country:US
Mailing Address - Phone:214-265-5050
Mailing Address - Fax:214-265-0523
Practice Address - Street 1:8440 WALNUT HILL LN STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3815
Practice Address - Country:US
Practice Address - Phone:214-265-5050
Practice Address - Fax:214-265-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2500207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00974ZMedicare PIN