Provider Demographics
NPI:1164986774
Name:TELL-A-NEURODOC, LLC
Entity Type:Organization
Organization Name:TELL-A-NEURODOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-590-2940
Mailing Address - Street 1:1113 NW 197TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3407
Mailing Address - Country:US
Mailing Address - Phone:405-696-3773
Mailing Address - Fax:405-424-3125
Practice Address - Street 1:1113 NW 197TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3407
Practice Address - Country:US
Practice Address - Phone:405-696-3773
Practice Address - Fax:405-424-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty