| Southwest Neurophysiology, Pllc | |
|
2452 Lakewood Dr Grand Prairie TX 75054-6800 | |
| (469) 343-5989 | |
| (888) 516-0585 |
| Full Name | Southwest Neurophysiology, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2452 Lakewood Dr, Grand Prairie, Texas |
| Authorized Official Name and Position | Uyenly Nguyen (OWNER) |
| Authorized Official Contact | 4693435989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Neurophysiology, Pllc Po Box 3591 Coppell TX 75019-5546 Ph: (469) 343-5984 | Southwest Neurophysiology, Pllc 2452 Lakewood Dr Grand Prairie TX 75054-6800 Ph: (469) 343-5989 |
| NPI Number | 1740832120 |
|---|---|
| Provider Enumeration Date | 07/15/2019 |
| Last Update Date | 02/18/2021 |
| Certification Date | 02/18/2021 |
| Medicare PECOS PAC ID | 6002242310 |
|---|---|
| Medicare Enrollment ID | O20200205001349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740832120 | NPI | - | NPPES |
| 00LZ77 | Other | TX | BCBS RECORD ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
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