1437278843 NPI number — THE CLINIC FOR SPECIAL SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437278843 NPI number — THE CLINIC FOR SPECIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CLINIC FOR SPECIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437278843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-335-5633
Provider Business Mailing Address Fax Number:
817-335-5304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-335-5633
Provider Business Practice Location Address Fax Number:
817-335-5304
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DILLIN
Authorized Official First Name:
PARKER
Authorized Official Middle Name:
LINDEN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
817-335-5633

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  000395 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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