Provider Demographics
NPI:1043670532
Name:MCGREEVY NEUROHEALTH PALM COAST
Entity Type:Organization
Organization Name:MCGREEVY NEUROHEALTH PALM COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-230-3006
Mailing Address - Street 1:559 W TWINCOURT TRL
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8805
Mailing Address - Country:US
Mailing Address - Phone:904-230-3006
Mailing Address - Fax:904-217-7114
Practice Address - Street 1:80 PINNACLES DR
Practice Address - Street 2:SUITE 700
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2323
Practice Address - Country:US
Practice Address - Phone:904-230-3006
Practice Address - Fax:904-217-7114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCGREEVY NEUROHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-26
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1090282084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD583WMedicare PIN