Provider Demographics
NPI:1811669583
Name:GREATER TEXAS ORTHOPEDIC ASSOCIATES, PLLC
Entity type:Organization
Organization Name:GREATER TEXAS ORTHOPEDIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-600-8706
Mailing Address - Street 1:324 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2241
Mailing Address - Country:US
Mailing Address - Phone:409-600-8700
Mailing Address - Fax:409-921-2157
Practice Address - Street 1:324 N 23RD ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2241
Practice Address - Country:US
Practice Address - Phone:409-600-8700
Practice Address - Fax:409-921-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center