Provider Demographics
NPI:1073539110
Name:JCL NEUROLOGY,LLC
Entity Type:Organization
Organization Name:JCL NEUROLOGY,LLC
Other - Org Name:SUN VALLEY NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, PND
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-216-6687
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:C-500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-439-7196
Mailing Address - Fax:602-439-7439
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:C-500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-439-7196
Practice Address - Fax:602-439-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105154Medicare PIN