Basic Information
| Provider Information | |||||||||
| NPI: | 1477562726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOGWOOD ORTHOPAEDIC CLINIC, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 612 N HIGH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HENDERSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756525914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036571441 | ||||||||
| FaxNumber: | 9036575886 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 N HIGH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HENDERSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756525914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036571441 | ||||||||
| FaxNumber: | 9036575886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 05/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | SESSIONS | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9036571441 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | 174400000X | G5595 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 085769002 | 01 | TX | MEDICAID DME | OTHER | 085769001 | 05 | TX | MEDICAID |