Organization
ORTHODOMICILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER O'BRIEN (BILLING SPECIALIST)
(816) 832-8804
Entity
Organization
Contact information
Practice address
5510 SUMMERHILL RD, TEXARKANA, TX 75503-1822
(903) 792-2710
Mailing address
5510 SUMMERHILL RD, TEXARKANA, TX 75503-1822
(903) 792-2710
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1411
TX
213E00000X
Podiatrist
180
AR
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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