Provider Demographics
NPI:1205233269
Name:AMARILLO BONE & JOINT CLINIC, LLP
Entity type:Organization
Organization Name:AMARILLO BONE & JOINT CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CST
Authorized Official - Phone:806-468-9700
Mailing Address - Street 1:1100 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1836
Mailing Address - Country:US
Mailing Address - Phone:806-468-9700
Mailing Address - Fax:806-468-9771
Practice Address - Street 1:1100 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1836
Practice Address - Country:US
Practice Address - Phone:806-468-9700
Practice Address - Fax:806-468-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137052246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty