Provider Demographics
NPI:1982755039
Name:JOHN TENNY, M.D., P.A.
Entity type:Organization
Organization Name:JOHN TENNY, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-283-8700
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1029
Mailing Address - Country:US
Mailing Address - Phone:972-283-8700
Mailing Address - Fax:972-283-8704
Practice Address - Street 1:3503 W WHEATLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:972-283-8700
Practice Address - Fax:972-283-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0845207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1143869-03Medicaid
TX00D43UOtherBLUE CROSS BLUE SHIELD
TX00666XMedicare ID - Type Unspecified
TX00D43UOtherBLUE CROSS BLUE SHIELD
TXC22542Medicare UPIN
TX00D43UOtherBLUE CROSS BLUE SHIELD