Provider Demographics
NPI:1104122621
Name:SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC
Entity type:Organization
Organization Name:SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOORANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-772-5770
Mailing Address - Street 1:2401 W GLENDALE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7677
Mailing Address - Country:US
Mailing Address - Phone:602-772-5770
Mailing Address - Fax:602-772-5771
Practice Address - Street 1:2401 W GLENDALE AVE STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7677
Practice Address - Country:US
Practice Address - Phone:602-772-5770
Practice Address - Fax:602-772-5771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-31
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ143146OtherPTAN
WA8293938Medicaid
WAH56794Medicare UPIN
AZZ129949Medicare PIN