Provider Demographics
NPI:1275847105
Name:SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL, LLC
Other - Org Name:O:A:S:I:S: HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:750 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6486
Mailing Address - Country:US
Mailing Address - Phone:602-797-7700
Mailing Address - Fax:602-797-7979
Practice Address - Street 1:750 N 40TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6486
Practice Address - Country:US
Practice Address - Phone:602-797-7700
Practice Address - Fax:602-797-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH5128284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ030131Medicare Oscar/Certification