Provider Demographics
NPI:1083332845
Name:NUROCOACH MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:NUROCOACH MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TACCARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-803-7877
Mailing Address - Street 1:101 SOUTHWESTERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3568
Mailing Address - Country:US
Mailing Address - Phone:855-954-6876
Mailing Address - Fax:855-859-6876
Practice Address - Street 1:2585 GRESHAM RD SE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4147
Practice Address - Country:US
Practice Address - Phone:855-954-6876
Practice Address - Fax:855-859-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174022248Medicaid
TX1235631599Medicaid
LA1902217581Medicaid
GA003291441AMedicaid