Organization
NORTH CENTRAL TEXAS ORTHOPAEDICS AND SPORTS MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL MCKENNA DO (DO)
(940) 627-3491
Entity
Organization
Contact information
Practice address
2800 E TX HIGHWAY 114 STE 130, TROPHY CLUB, TX 76262-5305
(469) 916-4435
(855) 959-1785
Mailing address
2800 E TX HWY 114, STE 130, TROPHY CLUB, TX 76262
(469) 916-4435
(855) 959-1785
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
J0118
TX
207X00000X
Orthopaedic Surgery Physician
K7089
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
M6477
TX
213E00000X
Podiatrist
1305
TX
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
J0118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080630901
—
TX
01
—
1141880001
DME
TX
01
—
89Z590
BCBS
TX
Enumeration date
04/24/2006
Last updated
12/24/2024
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