Provider Demographics
NPI:1114937380
Name:BELLAIRE NEUROLOGY, PA
Entity Type:Organization
Organization Name:BELLAIRE NEUROLOGY, PA
Other - Org Name:BELLAIRE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKELY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-715-6360
Mailing Address - Street 1:6700 WEST LOOP S
Mailing Address - Street 2:STE 330
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4104
Mailing Address - Country:US
Mailing Address - Phone:713-715-6360
Mailing Address - Fax:713-715-6367
Practice Address - Street 1:6700 WEST LOOP S
Practice Address - Street 2:STE 330
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4104
Practice Address - Country:US
Practice Address - Phone:713-715-6360
Practice Address - Fax:713-715-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF83650Medicare UPIN
TX00W929Medicare PIN