Provider Demographics
NPI: | 1265456362 |
---|---|
Name: | NEUROLOGICAL ASSOCIATES |
Entity Type: | Organization |
Organization Name: | NEUROLOGICAL ASSOCIATES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHANIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HIGGINBOTHAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 601-944-1717 |
Mailing Address - Street 1: | PO BOX 654 |
Mailing Address - Street 2: | |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38159-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 501 MARSHALL ST |
Practice Address - Street 2: | STE 501 |
Practice Address - City: | JACKSON |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39202-1651 |
Practice Address - Country: | US |
Practice Address - Phone: | 601-355-3353 |
Practice Address - Fax: | 601-355-3365 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-26 |
Last Update Date: | 2008-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MS | 09013343 | Medicaid |