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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