MEDICARE: SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1285980821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	8100 S. WALKER AVENUE
Second Line	:	BUILDING A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9404
Country	:	US
Telephone Number	:	405-632-4468
Fax Number	:	405-631-4964

Provider Business Practice Location Address
First Line	:	3130 HAYES AVE
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3601
Country	:	US
Telephone Number	:	580-323-8688
Fax Number	:	405-631-4964

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAMES DAVID MOORE
Credential	:
Telephone Number	:	405-632-4468

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	09/21/2020

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