Provider Demographics
NPI:1033370895
Name:SOUTH CENTRAL TEXAS NEUROLOGY PLLC
Entity Type:Organization
Organization Name:SOUTH CENTRAL TEXAS NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-379-4422
Mailing Address - Street 1:1331 E COURT ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5138
Mailing Address - Country:US
Mailing Address - Phone:830-379-4422
Mailing Address - Fax:830-379-4424
Practice Address - Street 1:1331 E COURT ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5138
Practice Address - Country:US
Practice Address - Phone:830-379-4422
Practice Address - Fax:830-379-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM88492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty