Southwest Neurodiagnostics LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

SOUTHWEST NEURODIAGNOSTICS LLC

Practice address

42104 N Venture Dr Ste A114
Anthem, AZ 85086-3825

Phone

(602) 395-0718

Fax

(602) 277-8146

NPI assigned

Apr 16, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cody D Davies

Title

Chief Operating Officer

Phone

(406) 599-4354

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1669969564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42104 N VENTURE DR STE A114",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850863825",
            "telephone_number": "406-599-4354",
            "fax_number": "602-798-8296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42104 N VENTURE DR STE A114",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850863825",
            "telephone_number": "602-395-0718",
            "fax_number": "602-277-8146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7878 N 16th St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850204478",
            "country_code": "US",
            "telephone_number": "602-395-0718 x129",
            "fax_number": "602-277-8146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST NEURODIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "DAVIES",
        "authorized_official_first_name": "CODY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "406-599-4354"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.