MEDICARE: SOUTHWEST NEUROLOGY P C

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	22788	AZ

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
2	1415509-3	OTHER	AZ	CORPORATION REGISTRATION

General Provider Information

NPI Number	:	1467637280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST NEUROLOGY P C

Provider Business Mailing Address
First Line	:	PO BOX 10499
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86427-0499
Country	:	US
Telephone Number	:	928-788-4260
Fax Number	:	928-788-4262

Provider Business Practice Location Address
First Line	:	5300 S HIGHWAY 95
Second Line	:	SUITE L
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-788-4260
Fax Number	:	928-788-4262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD S. BENNETT
Credential	:	M.D.
Telephone Number	:	928-788-4260

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	04/30/2008

Similar Medicare Providers

1164412110 — DR. RICHARD P BENEDICT MD
Practice Location Address:

5300 HIGHWAY 95 , STE K
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-788-7000
Practice Fax: 928-788-9900

1376518746 — DR. ERIC EUGENE BOROFSKY MD
Practice Location Address:

5300 S HIGHWAY 95 , SUITE D
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-788-3609
Practice Fax: 928-788-3607

1518935956 — TRI-STATE NEURO-SPINE INSTITUTE, P.L.C.
Practice Location Address:

5300 S HIGHWAY 95 , SUITE C
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-770-4515
Practice Fax: 928-770-4518

1780761809 — ZAK MEDICAL CENTER PC
Practice Location Address:

5300 S HIGHWAY 95 STE I , SUITE I
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-788-1911
Practice Fax: 928-788-1920

1033359583 — VALLEY VIEW PHYSICIAN PRACTICES LLC
Practice Location Address:

5300 S HIGHWAY 95 , SUITE D
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-788-3609
Practice Fax: 928-788-3607

1144455478 — VALLEY VIEW PHYSICIAN PRACTICES LLC
Practice Location Address:

5300 S HIGHWAY 95 , SUITE K
FORT MOHAVE, AZ
86426-9251

Practice Phone: 928-768-4499
Practice Fax: 928-768-6499

Directions to “SOUTHWEST NEUROLOGY P C ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.