MEDICARE: SOUTHWEST ORTHOPEDIC TECHNOLOGISTS

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	332B00000X	Durable Medical Equipment & Medical Supplies	05-1113	TX

General Provider Information

NPI Number	:	1811168438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ORTHOPEDIC TECHNOLOGISTS

Provider Business Mailing Address
First Line	:	1051 MILL VALLEY RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79927-4881
Country	:	US
Telephone Number	:	915-820-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 MILL VALLEY RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79927-4881
Country	:	US
Telephone Number	:	915-820-8857
Fax Number	:

Authorized Official
Title or Position	:	ORTHOPEDIC TECHNOLOGIST CERTIFIED
Name	:	MR. ALEJANDRO LUIS BECERRA
Credential	:	O.T.C.
Telephone Number	:	915-820-8857

Provider Enumeration Date	:	03/23/2008
Last Update Date	:	03/23/2008

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