Provider Demographics
NPI:1194865642
Name:NEUROLOGY SPECIALISTS, PC
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-330-0303
Mailing Address - Street 1:813 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2212
Mailing Address - Country:US
Mailing Address - Phone:812-330-0303
Mailing Address - Fax:812-330-0404
Practice Address - Street 1:813 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2212
Practice Address - Country:US
Practice Address - Phone:812-330-0303
Practice Address - Fax:812-330-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060196A2084N0400X
IN10000690A363AM0700X
IN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI26292Medicare UPIN
INF98378Medicare UPIN
IN203650Medicare ID - Type Unspecified
INQ23073Medicare UPIN