Provider Demographics
NPI:1902186422
Name:TEXAS NON-SURGICAL ORTHOPEDIC & PAIN MANAGEMENT CLINIC
Entity Type:Organization
Organization Name:TEXAS NON-SURGICAL ORTHOPEDIC & PAIN MANAGEMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-643-5513
Mailing Address - Street 1:2900 COGGIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5331
Mailing Address - Country:US
Mailing Address - Phone:325-643-5513
Mailing Address - Fax:325-646-9964
Practice Address - Street 1:2900 COGGIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5331
Practice Address - Country:US
Practice Address - Phone:325-643-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6662207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty