Provider Demographics
NPI:1790290484
Name:SOUTHWEST SCOLIOSIS INSTITUTE, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST SCOLIOSIS INSTITUTE, PLLC
Other - Org Name:SOUTHWEST PEDIATRIC ORTHOPEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING/AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-985-2797
Mailing Address - Street 1:1600 COIT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6171
Mailing Address - Country:US
Mailing Address - Phone:972-985-2797
Mailing Address - Fax:972-985-4797
Practice Address - Street 1:1600 COIT RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6171
Practice Address - Country:US
Practice Address - Phone:972-985-2797
Practice Address - Fax:972-985-4797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST SCOLIOSIS INSTITUTE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-04
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty