Provider Demographics
NPI:1073926473
Name:MEDCENTER NEURO PLLC
Entity Type:Organization
Organization Name:MEDCENTER NEURO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-615-5168
Mailing Address - Street 1:PO BOX 3837
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60132-3837
Mailing Address - Country:US
Mailing Address - Phone:214-615-5168
Mailing Address - Fax:888-526-9542
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 2020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:214-615-5168
Practice Address - Fax:888-526-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty