Organization
JPS PHYSICIAN GROUP, INC
Active
Other names
Southwest Sports and Spine Center
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JOHNSON (DIRECTOR OF OPERATIONS)
(817) 920-3887
Entity
Organization
Contact information
Practice address
1617 HEMPHILL ST, FORT WORTH, TX 76104-4709
(817) 920-6245
Mailing address
7148 TRAIL LAKE DR, FORT WORTH, TX 76123-1969
(817) 920-6245
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
07/29/2011
Last updated
07/29/2011
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