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Organization
ORTHOPEDIC SURGERY PAVILION, LP
Active
Organization
ORTHOPEDIC SURGERY PAVILION, LP
Active
Other names
Orthopedic Surgery Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH MILNE M.D. (MEDICAL DIRECTOR)
(817) 493-2356
Entity
Organization
Contact information
Practice address
2001 COOPER ST, FORT WORTH, TX 76104-2529
(817) 877-1291
(817) 877-1292
Mailing address
PO BOX 961094, FORT WORTH, TX 76161-0094
(817) 877-1291
(817) 877-1292
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
007075
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60054
AETNA
TX
01
—
75261
PHCS
TX
01
—
HH1507
BLUE CROSS BUE SHIELD
TX
01
—
RRMCHCX12
RAILROAD MEDICARE
TX
Enumeration date
07/20/2005
Last updated
08/22/2020
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