=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588625412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHLUTERMAN NEUROLOGY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2006
-----------------------------------------------------
Last Update Date | 12/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 ADA AVE
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-4985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-932-0352
-----------------------------------------------------
Fax | 501-932-0354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 ADA AVE
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-4986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-932-0352
-----------------------------------------------------
Fax | 501-932-0354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEITH O SCHLUTERMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 501-932-0352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | E3984
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------