Provider Demographics
NPI:1740832120
Name:SOUTHWEST NEUROPHYSIOLOGY, PLLC
Entity type:Organization
Organization Name:SOUTHWEST NEUROPHYSIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UYENLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM R EPT, R CNST
Authorized Official - Phone:469-343-5989
Mailing Address - Street 1:PO BOX 3591
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5546
Mailing Address - Country:US
Mailing Address - Phone:469-343-5984
Mailing Address - Fax:888-516-0585
Practice Address - Street 1:2452 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6800
Practice Address - Country:US
Practice Address - Phone:469-343-5989
Practice Address - Fax:888-516-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LZ77OtherBCBS RECORD ID