Provider Demographics
NPI:1083725220
Name:NEUROSURGICAL ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-1100
Mailing Address - Street 1:7130 N SHARON AVE
Mailing Address - Street 2:#100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3386
Mailing Address - Country:US
Mailing Address - Phone:559-449-1100
Mailing Address - Fax:559-449-1174
Practice Address - Street 1:7130 N SHARON AVE
Practice Address - Street 2:#100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3386
Practice Address - Country:US
Practice Address - Phone:559-449-1100
Practice Address - Fax:559-449-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA195946200OtherUSDL
CACS6929OtherRAILROAD MEDICARE
CAGR008950Medicaid
CA5367510001OtherMEDICARE DMEPOS
CA5367510001Medicare NSC
CAZZZ13026ZMedicare PIN