Provider Demographics
NPI:1235362195
Name:NEUROCARE CENTER PC
Entity Type:Organization
Organization Name:NEUROCARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-439-9000
Mailing Address - Street 1:923 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6431
Mailing Address - Country:US
Mailing Address - Phone:575-439-9000
Mailing Address - Fax:575-439-9144
Practice Address - Street 1:923 9TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6431
Practice Address - Country:US
Practice Address - Phone:575-439-9000
Practice Address - Fax:575-439-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-05732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467557124OtherINDIVIDUAL NPI
MI104895900Medicaid
1467557124OtherINDIVIDUAL NPI