Provider Demographics
NPI:1235207515
Name:SOUTHWEST PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-2379
Mailing Address - Street 1:937 SW 89TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9231
Mailing Address - Country:US
Mailing Address - Phone:405-631-2379
Mailing Address - Fax:
Practice Address - Street 1:937 SW 89TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9231
Practice Address - Country:US
Practice Address - Phone:405-631-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100735080BMedicaid