MEDICARE: SOUTHWEST SURGICAL ONCOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	2086X0206X	Surgical Oncology Physician

General Provider Information

NPI Number	:	1134124852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST SURGICAL ONCOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	7777 FOREST LN
Second Line	:	STE C-585
City	:	DALLAS
State	:	TX
Zip	:	75230-2505
Country	:	US
Telephone Number	:	972-566-4880
Fax Number	:	972-566-6256

Provider Business Practice Location Address
First Line	:	7777 FOREST LN
Second Line	:	STE C585
City	:	DALLAS
State	:	TX
Zip	:	75230-2505
Country	:	US
Telephone Number	:	972-566-4880
Fax Number	:	972-566-6256

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MS. NITA PICKETT
Credential	:
Telephone Number	:	972-566-4880

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/07/2010

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