Basic Information
Provider Information
NPI: 1003016718
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HRNACK
FirstName: SCOTT
MiddleName: ALLAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1149 KELLER PKWY STE A
Address2:  
City: KELLER
State: TX
PostalCode: 762481620
CountryCode: US
TelephoneNumber: 8175621040
FaxNumber: 8175621043
Practice Location
Address1: 1149 KELLER PKWY STE A
Address2:  
City: KELLER
State: TX
PostalCode: 762481620
CountryCode: US
TelephoneNumber: 9403821577
FaxNumber: 9403875471
Other Information
ProviderEnumerationDate: 07/20/2007
LastUpdateDate: 12/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005XM7280TXY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

ID Information
IDTypeStateIssuerDescription
80433301TXMEDICARE PINOTHER
P0224758801TXRAILROAD MEDICAREOTHER
21994320105TX MEDICAID
8CL99001TXBCBSOTHER
8KW88301TXBCBSOTHER


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