Basic Information
| Provider Information | |||||||||
| NPI: | 1538544986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC | ||||||||
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| OtherOrganizationName: | SOUTHWEST ORTHOPAEDIC & RECONSTRUCTIVE SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 S. WALKER AVENUE | ||||||||
| Address2: | BUILDING A | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731399404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056324468 | ||||||||
| FaxNumber: | 4056314964 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 N. GLENN ENGLISH | ||||||||
| Address2: | |||||||||
| City: | CORDELL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056324468 | ||||||||
| FaxNumber: | 4056320436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4056324468 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.