Provider Demographics
NPI:1043358005
Name:NEUROLOGICAL CARE CENTER, L.L.C.
Entity Type:Organization
Organization Name:NEUROLOGICAL CARE CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-733-4262
Mailing Address - Street 1:2736 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2179
Mailing Address - Country:US
Mailing Address - Phone:904-733-4262
Mailing Address - Fax:904-636-5786
Practice Address - Street 1:2736 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2179
Practice Address - Country:US
Practice Address - Phone:904-733-4262
Practice Address - Fax:904-636-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty