MEDICARE: SOUTHWEST NEUROLOGICL INSTITUTE PA

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265688956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST NEUROLOGICL INSTITUTE PA

Provider Business Mailing Address
First Line	:	P.O. BOX 3890
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72913
Country	:	US
Telephone Number	:	479-784-9800
Fax Number	:	479-784-9817

Provider Business Practice Location Address
First Line	:	3011 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901
Country	:	US
Telephone Number	:	479-784-9800
Fax Number	:	479-784-9817

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM L GRIGGS III
Credential	:	MD
Telephone Number	:	479-784-9800

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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