Provider Demographics
NPI:1225166903
Name:M & G NEUROPHYSIOLOGY INC
Entity Type:Organization
Organization Name:M & G NEUROPHYSIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-923-8504
Mailing Address - Street 1:4338 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-5432
Mailing Address - Country:US
Mailing Address - Phone:606-585-0888
Mailing Address - Fax:
Practice Address - Street 1:4338 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5432
Practice Address - Country:US
Practice Address - Phone:606-585-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65943573Medicaid
WV3810002260Medicaid
KYP00234784OtherRAIL ROAD MC
KY65943573Medicaid
WV3810002260Medicaid