Provider Demographics
NPI:1871739383
Name:JASON C TINLEY, MD, PLLC
Entity type:Organization
Organization Name:JASON C TINLEY, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:TINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-916-4685
Mailing Address - Street 1:4441 BRYANT IRVIN RD N
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7338
Mailing Address - Country:US
Mailing Address - Phone:817-916-4685
Mailing Address - Fax:
Practice Address - Street 1:4441 BRYANT IRVIN RD N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7338
Practice Address - Country:US
Practice Address - Phone:817-916-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7690207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6277660001Medicare NSC