Provider Demographics
NPI:1093836181
Name:SOUTHWEST ORTHOPAEDICS, INC.
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-842-1570
Mailing Address - Street 1:18660 BAGLEY ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-243-2100
Mailing Address - Fax:440-243-5706
Practice Address - Street 1:18660 BAGLEY ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-243-2100
Practice Address - Fax:440-243-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0302930003Medicare NSC