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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