Provider Demographics
NPI:1073629119
Name:NEUROLOGICAL SPECIALISTS PSC
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOVEGILDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-769-6875
Mailing Address - Street 1:PO BOX 2607
Mailing Address - Street 2:1237 WOODLAWN DRIVE
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-769-6875
Mailing Address - Fax:270-737-9696
Practice Address - Street 1:1237 WOODLAWN DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-769-6875
Practice Address - Fax:270-737-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174982084N0400X
KY200072084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty