Provider Demographics
NPI:1164580940
Name:NEUROSURGICAL NETWORK, INC.
Entity Type:Organization
Organization Name:NEUROSURGICAL NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-251-1155
Mailing Address - Street 1:2222 CHERRY ST STE M200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2674
Mailing Address - Country:US
Mailing Address - Phone:419-251-1155
Mailing Address - Fax:
Practice Address - Street 1:2113 TIFFIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9504
Practice Address - Country:US
Practice Address - Phone:888-251-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2158856Medicaid
OH2158856Medicaid