Provider Demographics
NPI:1548229164
Name:SUSAN K LINDER MD PA
Entity type:Organization
Organization Name:SUSAN K LINDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-926-7671
Mailing Address - Street 1:PO BOX 961013
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0013
Mailing Address - Country:US
Mailing Address - Phone:817-926-7671
Mailing Address - Fax:817-926-7772
Practice Address - Street 1:2800 S HULEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1504
Practice Address - Country:US
Practice Address - Phone:817-926-7671
Practice Address - Fax:817-926-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00366ZMedicare PIN
F73989Medicare UPIN
TX00L11WMedicare PIN