Basic Information
| Provider Information | |||||||||
| NPI: | 1760772669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOTEXAS PHYSICIANS AND SURGEONS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 N JOSEY LN | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4951 LONG PRAIRIE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728994679 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | RATLEY | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC VP | ||||||||
| AuthorizedOfficialTelephone: | 9723952220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | TXB117492 | 01 | TX | MEDICARE PART B GROUP PTAN | OTHER | DR2337 | 01 | TX | RAILROAD MEDICARE | OTHER | 0052WC | 01 | TX | BC/BS TX GROUP | OTHER |