Provider Demographics
NPI:1467641977
Name:SOUTHWEST NEUROLOGY INC
Entity Type:Organization
Organization Name:SOUTHWEST NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMPSAGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAVISHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-826-9221
Mailing Address - Street 1:7215 OLD OAK BLVD
Mailing Address - Street 2:A411
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3340
Mailing Address - Country:US
Mailing Address - Phone:440-826-9221
Mailing Address - Fax:440-816-5399
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:A411
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3340
Practice Address - Country:US
Practice Address - Phone:440-826-9221
Practice Address - Fax:440-816-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-21
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068631204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500150OtherUNITED HEATHCARE INS
OH0946169Medicaid
OH108691OtherKAISER INS
OH1579165OtherCIGNA
OHP00036566OtherMEDICARE RAILROAD
OH203918OtherANTHEM
OH7543555OtherAETNA INS
OH9344111Medicare PIN
OH0946169Medicaid