MEDICARE: SOUTHWEST NEUROLOIGICAL 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	R2071	AR

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	:	1952692808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST NEUROLOIGICAL INSTITUTE,PA

Provider Business Mailing Address
First Line	:	3011 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6736
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	:	72901-6736
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	:	04/27/2011
Last Update Date	:	05/09/2011

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