Provider Demographics
NPI:1376698365
Name:NORTHWESTERN NEUROLOGY
Entity Type:Organization
Organization Name:NORTHWESTERN NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PIERPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-825-4711
Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:13101 N ORACLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9554
Practice Address - Country:US
Practice Address - Phone:520-825-4711
Practice Address - Fax:520-825-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24067261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67518OtherMEDICARE PTAN
AZZ67518OtherMEDICARE PTAN