Organization
AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.
Active
Other names
Southwest Orthopaedic Group
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN L SULLIVAN (PHYSICIAN)
(512) 451-1969
Entity
Organization
Contact information
Practice address
441 HWY 71 W, SUITE F, BASTROP, TX 78602-3931
(512) 451-1969
(512) 458-2327
Mailing address
2500 W WILLIAM CANNON DR, SUITE 401, AUSTIN, TX 78745-5257
(512) 451-1969
(512) 458-2327
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
K7496
TX
207XS0106X
Orthopaedic Hand Surgery Physician
K9864
TX
332B00000X
Durable Medical Equipment & Medical Supplies
K7496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2103178-01
—
TX
Enumeration date
06/16/2010
Last updated
01/15/2021
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