Provider Demographics
NPI:1477624757
Name:SOUTHWEST SURGICAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:SOUTHWEST SURGICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-255-6355
Mailing Address - Street 1:13811 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4903
Mailing Address - Country:US
Mailing Address - Phone:713-255-6310
Mailing Address - Fax:713-255-6315
Practice Address - Street 1:7777 SOUTHWEST FWY STE 810
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1811
Practice Address - Country:US
Practice Address - Phone:713-772-1200
Practice Address - Fax:713-772-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77074A001OtherGROUP TRICARE ID#
TX083465701Medicaid
TXCS7997OtherRR MEDICARE PIN
TX083465701Medicaid