Provider Demographics
NPI:1083716138
Name:SOUTHWESTERN COLON & RECTAL SURGERY, PA
Entity Type:Organization
Organization Name:SOUTHWESTERN COLON & RECTAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:LERMA
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-447-8911
Mailing Address - Street 1:4007 JAMES CASEY DR STE D150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3346
Mailing Address - Country:US
Mailing Address - Phone:512-447-8911
Mailing Address - Fax:
Practice Address - Street 1:4007 JAMES CASEY DR STE D150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3346
Practice Address - Country:US
Practice Address - Phone:512-447-8911
Practice Address - Fax:512-447-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9880OtherBCBS
TX8B9880OtherBCBS