Provider Demographics
NPI:1073644498
Name:SOUTHWEST ORTHOPEDIC GROUP, LLP
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPEDIC GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-610-4270
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1016
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-610-4270
Mailing Address - Fax:713-610-4271
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1016
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-610-4270
Practice Address - Fax:713-610-4271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518383-01Medicaid
TX00622TMedicare PIN
TX0A5898Medicare PIN