Provider Demographics
NPI:1164720942
Name:PIERCEY NEUROLOGY LLC
Entity Type:Organization
Organization Name:PIERCEY NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5412-073-9000
Mailing Address - Street 1:650 SW 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4437
Mailing Address - Country:US
Mailing Address - Phone:541-207-3900
Mailing Address - Fax:541-207-3232
Practice Address - Street 1:650 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4437
Practice Address - Country:US
Practice Address - Phone:541-207-3900
Practice Address - Fax:541-207-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD224632084N0400X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6722980001Medicare PIN