Healthcare Provider Details

I. General information

NPI: 1962234682
Provider Name (Legal Business Name): SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 W IOWA AVE
CHICKASHA OK
73018-2736
US

IV. Provider business mailing address

8100 S WALKER AVE BLDG A
OKLAHOMA CITY OK
73139-9475
US

V. Phone/Fax

Practice location:
  • Phone: 405-779-2158
  • Fax: 405-632-0436
Mailing address:
  • Phone: 405-632-4468
  • Fax: 405-632-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOE STREICH
Title or Position: CEO
Credential:
Phone: 405-619-4410