Provider Demographics
NPI:1699870808
Name:CROSS TIMBERS ORTHOPAEDICS
Entity type:Organization
Organization Name:CROSS TIMBERS ORTHOPAEDICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-965-2663
Mailing Address - Street 1:561 N GRAHAM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3548
Mailing Address - Country:US
Mailing Address - Phone:254-965-2663
Mailing Address - Fax:254-968-7979
Practice Address - Street 1:561 N GRAHAM ST STE 101
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3548
Practice Address - Country:US
Practice Address - Phone:254-965-2663
Practice Address - Fax:254-968-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4103174400000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1243790001Medicare NSC
TX00434TMedicare PIN