1467641977 NPI number — SOUTHWEST NEUROLOGY INC

Table of Contents

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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