Provider Demographics
NPI:1003281577
Name:NEUROSCIENCE CENTER OF THE SOUTH
Entity Type:Organization
Organization Name:NEUROSCIENCE CENTER OF THE SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMANGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-801-0575
Mailing Address - Street 1:76 STARBRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7208
Mailing Address - Country:US
Mailing Address - Phone:985-892-8934
Mailing Address - Fax:985-871-8109
Practice Address - Street 1:76 STARBRUSH CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7208
Practice Address - Country:US
Practice Address - Phone:985-892-8934
Practice Address - Fax:985-871-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty