Provider Demographics
NPI: | 1669559720 |
---|---|
Name: | SOUTHWEST ORTHOPAEDIC SPECIALISTS, P.L.L.C. |
Entity type: | Organization |
Organization Name: | SOUTHWEST ORTHOPAEDIC SPECIALISTS, P.L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STREICH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 405-619-4410 |
Mailing Address - Street 1: | 8100 S WALKER AVE BLDG A |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73139-9475 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-632-4468 |
Mailing Address - Fax: | 405-631-4964 |
Practice Address - Street 1: | 8100 S WALKER AVE BLDG A |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73139-9475 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-632-4468 |
Practice Address - Fax: | 405-632-0436 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-01 |
Last Update Date: | 2024-12-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 2086S0105X | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 100745060A | Medicaid | |
0440400001 | Medicare NSC |