1467641977 NPI number — SOUTHWEST NEUROLOGY INC

Table of content: (NPI 1467641977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467641977 NPI number — SOUTHWEST NEUROLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST NEUROLOGY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467641977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7215 OLD OAK BLVD
Provider Second Line Business Mailing Address:
A411
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-826-9221
Provider Business Mailing Address Fax Number:
440-816-5399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7215 OLD OAK BLVD
Provider Second Line Business Practice Location Address:
A411
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-826-9221
Provider Business Practice Location Address Fax Number:
440-816-5399
Provider Enumeration Date:
10/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAVISHANKAR
Authorized Official First Name:
KEMPSAGER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
440-826-9221

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  35068631 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0500150 . This is a "UNITED HEATHCARE INS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0946169 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108691 . This is a "KAISER INS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1579165 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00036566 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 203918 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7543555 . This is a "AETNA INS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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