Basic Information
| Provider Information | |||||||||
| NPI: | 1972582690 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TMI SPORTS MEDICINE AND ORTHOPEDIC SURGERY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3533 MATLOCK ROAD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760153604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174190303 | ||||||||
| FaxNumber: | 8174685963 | ||||||||
| Practice Location | |||||||||
| Address1: | 3533 MATLOCK ROAD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760153604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174190303 | ||||||||
| FaxNumber: | 8174685963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEISTER | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8174190303 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 166442704 | 05 | TX | MEDICAID |