Provider Demographics
NPI:1033512322
Name:SPECTRUM NEUROLOGY CENTER LLC
Entity Type:Organization
Organization Name:SPECTRUM NEUROLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCOUDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-7246
Mailing Address - Street 1:3409 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4611
Mailing Address - Country:US
Mailing Address - Phone:504-454-7246
Mailing Address - Fax:504-454-3299
Practice Address - Street 1:3409 DIVISION ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4611
Practice Address - Country:US
Practice Address - Phone:504-454-7246
Practice Address - Fax:504-454-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201074261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty