Provider Demographics
NPI:1740464320
Name:ORTHOPEDIC TRAUMA SURGEONS LLP
Entity type:Organization
Organization Name:ORTHOPEDIC TRAUMA SURGEONS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-883-5003
Mailing Address - Street 1:2601 HOSPITAL BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1858
Mailing Address - Country:US
Mailing Address - Phone:361-883-5003
Mailing Address - Fax:361-883-5003
Practice Address - Street 1:2601 HOSPITAL BLVD STE 207
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1858
Practice Address - Country:US
Practice Address - Phone:361-883-5003
Practice Address - Fax:361-883-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6773207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090BYMedicare PIN