Provider Demographics
NPI:1003837048
Name:NEUROLOGICAL ASSOCIATES OF SOUTHEAST OHIO INC
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF SOUTHEAST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-453-0680
Mailing Address - Street 1:945 BETHESDA DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0801
Mailing Address - Country:US
Mailing Address - Phone:740-453-0680
Mailing Address - Fax:740-453-5158
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 230
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-453-0680
Practice Address - Fax:740-453-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350390442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308223Medicaid
OH000000117692OtherBLUE CROSS PROVIDER NUMBE
OHA75587Medicare UPIN
OH9915562Medicare PIN