Healthcare Provider Details

I. General information

NPI: 1659627289
Provider Name (Legal Business Name): SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 NORTH HARRISON AVENUE
SHAWNEE OK
74804-4022
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-395-9050
  • Fax: 405-631-4964
Mailing address:
  • Phone: 405-632-4468
  • Fax: 405-631-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
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