Provider Demographics
NPI:1134124852
Name:SOUTHWEST SURGICAL ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST SURGICAL ONCOLOGY ASSOCIATES
Other - Org Name:ROBERT M. STECKLER, M.D. & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-566-4880
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:STE C-585
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-4880
Mailing Address - Fax:972-566-6256
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE C585
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4880
Practice Address - Fax:972-566-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00335TMedicare ID - Type UnspecifiedGROUP #