Provider Demographics
NPI:1083679609
Name:NEUROLOGY ASSOCIATES OF ORMOND BEACH PA
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF ORMOND BEACH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-2500
Mailing Address - Street 1:8 MIRROR LAKE DR
Mailing Address - Street 2:STE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5935
Mailing Address - Country:US
Mailing Address - Phone:386-673-2500
Mailing Address - Fax:386-673-3204
Practice Address - Street 1:8 MIRROR LAKE DR
Practice Address - Street 2:STE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5935
Practice Address - Country:US
Practice Address - Phone:386-673-2500
Practice Address - Fax:386-673-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250638600Medicaid
FLCC7418OtherRAILROAD MEDICARE
FL40662OtherBLUE CROSS
FL250638600Medicaid
FL40662Medicare PIN