Provider Demographics
NPI:1073873519
Name:SOUTHWEST SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST SURGICAL ASSOCIATES
Other - Org Name:CHRISTOPHER LYNCH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:CST/CSFA/RN
Authorized Official - Phone:817-808-8467
Mailing Address - Street 1:PO BOX 101292
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-1292
Mailing Address - Country:US
Mailing Address - Phone:817-808-8467
Mailing Address - Fax:817-921-3352
Practice Address - Street 1:4216 SW LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5350
Practice Address - Country:US
Practice Address - Phone:817-808-8467
Practice Address - Fax:817-921-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808232163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7332427OtherAETNA HEALTHCARE
UT2285573OtherUNITED HEALTHCARE