Organization
NORTH TEXAS SPORTS AND ORTHOPEDIC CENTER, PLLC
Active
Organization
NORTH TEXAS SPORTS AND ORTHOPEDIC CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF HENDERSON (VP)
(972) 401-8720
Entity
Organization
Contact information
Practice address
2020 W STATE HIGHWAY 114, SUITE 110, GRAPEVINE, TX 76051-8649
(817) 310-0810
(817) 812-3525
Mailing address
2020 W STATE HIGHWAY 114, SUITE 110, GRAPEVINE, TX 76051-8649
(817) 310-0810
(817) 812-3525
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206596301
—
TX
01
—
DP1378
RR MEDICARE GROUP PTAN
TX
01
—
P00755495
RAILROAD MEDICARE PTAN
TX
Enumeration date
05/05/2009
Last updated
01/27/2010
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