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General NPI Number Information
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NPI Number | 1477595924
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN NEUROSURGERY PHYSICIANS LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/23/2008
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Provider Practice Location Address
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Address Line | 5604 SW LEE BLVD SUITE 357
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City | LAWTON
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State | OK
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Zip | 73505-9681
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Country | US
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Telephone | 580-531-4600
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Fax | 580-531-6405
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Provider Business Mailing Address
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Address Line | 5604 SW LEE BLVD SUITE 357
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City | LAWTON
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State | OK
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Zip | 73505-9681
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Country | US
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Telephone | 580-531-4600
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Fax | 580-531-6405
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Authorized Official
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Title or Position | CEO
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Name | MR. JON O'SHAUGHNESSY
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Credential |
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Telephone | 580-531-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25895
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25956
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 26013
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 23774
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License Number State | OK
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