Provider Demographics
NPI:1235262239
Name:NEUROLOGY SERVICES OF SOUTHWEST VIRGINIA
Entity Type:Organization
Organization Name:NEUROLOGY SERVICES OF SOUTHWEST VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-961-0410
Mailing Address - Street 1:210 PROFESSIONAL PARK DR SE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6680
Mailing Address - Country:US
Mailing Address - Phone:540-961-0410
Mailing Address - Fax:540-961-3925
Practice Address - Street 1:210 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 12
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6680
Practice Address - Country:US
Practice Address - Phone:540-961-0410
Practice Address - Fax:540-961-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty