Provider Demographics
NPI:1871514679
Name:SPORTS & ORTHOPAEDIC GROUP OF DALLAS
Entity type:Organization
Organization Name:SPORTS & ORTHOPAEDIC GROUP OF DALLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-369-7733
Mailing Address - Street 1:6901 SNIDER PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5651
Mailing Address - Country:US
Mailing Address - Phone:214-369-7733
Mailing Address - Fax:214-369-7739
Practice Address - Street 1:6901 SNIDER PLZ
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5651
Practice Address - Country:US
Practice Address - Phone:214-369-7733
Practice Address - Fax:214-369-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207X00000X, 207XX0005X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ76006Medicare UPIN
TX00923PMedicare ID - Type UnspecifiedDR. WALTER GREAR HURT
TX00892MMedicare ID - Type UnspecifiedDR. MELVIN R. MANNING
TX0071AMMedicare ID - Type UnspecifiedDR. RICHARD S. LEVY
TXG11979Medicare UPIN
TXC22087Medicare UPIN
TXH61014Medicare UPIN