Provider Demographics
NPI:1457393928
Name:SOUTHWEST ORTHOPAEDICS, INC.
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPAEDICS, INC.
Other - Org Name:SOUTHWEST ORTHOPAEDICS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-842-1570
Mailing Address - Street 1:6115 POWERS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5471
Mailing Address - Country:US
Mailing Address - Phone:440-842-1570
Mailing Address - Fax:440-842-8230
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-842-1570
Practice Address - Fax:440-842-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9234361Medicare PIN
OH9234362Medicare PIN