Provider Demographics
NPI:1265688956
Name:SOUTHWEST NEUROLOGICL INSTITUTE PA
Entity Type:Organization
Organization Name:SOUTHWEST NEUROLOGICL INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:479-784-9800
Mailing Address - Street 1:P.O. BOX 3890
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913
Mailing Address - Country:US
Mailing Address - Phone:479-784-9800
Mailing Address - Fax:479-784-9817
Practice Address - Street 1:3011 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901
Practice Address - Country:US
Practice Address - Phone:479-784-9800
Practice Address - Fax:479-784-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136522002Medicaid