Provider Demographics
NPI:1578762381
Name:SOUTHWEST ORTHOPEDIC GROUP, LLP
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPEDIC GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-610-4270
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1016
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-610-4270
Mailing Address - Fax:173-610-4261
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE 111
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-428-1001
Practice Address - Fax:281-422-5959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST ORTHOPEDIC GROUP, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4541720004Medicare NSC