Provider Demographics
NPI:1316508724
Name:O&W SURGICAL PLLC
Entity type:Organization
Organization Name:O&W SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-356-7482
Mailing Address - Street 1:2200 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4030
Mailing Address - Country:US
Mailing Address - Phone:806-452-7221
Mailing Address - Fax:806-452-7231
Practice Address - Street 1:2200 W 4TH AVE
Practice Address - Street 2:STE 207
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4030
Practice Address - Country:US
Practice Address - Phone:806-452-7221
Practice Address - Fax:806-452-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty