Organization
CENTRAL TEXAS ORTHOPEDIC SURGERY,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRESCENT L CLARK (MANAGER)
(325) 643-5513
Entity
Organization
Contact information
Practice address
2510 CROCKETT DR, SUITE A, BROWNWOOD, TX 76801-5928
(325) 643-5513
Mailing address
2510 CROCKETT DR, SUITE A, BROWNWOOD, TX 76801-5928
(325) 643-5513
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
J6662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040AV
BLUE CROSS BLUE SHIELD TX
TX
01
—
119756
SUPERIOR HEALTH PLAN
TX
05
—
127632105
—
TX
01
—
181622100
DEPT OF LABOR
TX
01
—
8X1180
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
09/26/2006
Last updated
07/22/2008
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