Provider Demographics
NPI:1164502738
Name:CAROLINA NEUROLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CAROLINA NEUROLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-327-9869
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:STE 202
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-327-9869
Mailing Address - Fax:828-327-3541
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:STE 202
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-9869
Practice Address - Fax:828-327-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X
NC168302084N0400X
NC322882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015JTMedicaid
NC2335652Medicare PIN
NC89015JTMedicaid