Provider Demographics
NPI:1952396996
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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
Mailing Address - Street 2:SUITE 330
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-556-2885
Mailing Address - Fax:972-506-8733
Practice Address - Street 1:400 W LBJ FWY
Practice Address - Street 2:SUITE 330
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-556-2885
Practice Address - Fax:972-506-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080919601Medicaid
TX0063AZMedicare ID - Type Unspecified