| Southwest Neurology P C | |
|
5300 S Highway 95 Suite L Fort Mohave AZ 86426-9251 | |
| (928) 788-4260 | |
| (928) 788-4262 |
| Full Name | Southwest Neurology P C |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 5300 S Highway 95, Fort Mohave, Arizona |
| Authorized Official Name and Position | Ronald S. Bennett (PRESIDENT) |
| Authorized Official Contact | 9287884260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Neurology P C Po Box 10499 Fort Mohave AZ 86427-0499 Ph: (928) 788-4260 | Southwest Neurology P C 5300 S Highway 95 Suite L Fort Mohave AZ 86426-9251 Ph: (928) 788-4260 |
| NPI Number | 1467637280 |
|---|---|
| Provider Enumeration Date | 12/31/2007 |
| Last Update Date | 04/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467637280 | NPI | - | NPPES |
| 215691002 | Medicaid | AZ | |
| 1415509-3 | Other | AZ | CORPORATION REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 22788 (Arizona) | Primary |
Virtual Edge Therapies Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4329 S River Valley Ct Ste A, Fort Mohave, AZ 86426 Phone: 619-818-7841 |