Provider Demographics
NPI:1114041548
Name:NEURO RESOURCE PC
Entity Type:Organization
Organization Name:NEURO RESOURCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-868-0200
Mailing Address - Street 1:3443 DICKERSON PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2523
Mailing Address - Country:US
Mailing Address - Phone:615-868-0200
Mailing Address - Fax:615-865-5999
Practice Address - Street 1:3443 DICKERSON PIKE STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2523
Practice Address - Country:US
Practice Address - Phone:615-868-0200
Practice Address - Fax:615-865-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEURO RESOURCE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0129432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2000950OtherBLUE CROSS BLUE SHIELD
TN3184804Medicaid
TN3184804Medicaid