Provider Demographics
NPI:1093598690
Name:NEURALOGIX MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:NEURALOGIX MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-491-4987
Mailing Address - Street 1:5150 HIGHWAY 22 STE C10
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2669
Mailing Address - Country:US
Mailing Address - Phone:504-491-4987
Mailing Address - Fax:
Practice Address - Street 1:2506 LAKELAND DR STE 110A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7640
Practice Address - Country:US
Practice Address - Phone:833-274-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty