Provider Demographics
NPI:1285822775
Name:NEUROLOGICAL SERVICES OF TEXAS, P.A.
Entity Type:Organization
Organization Name:NEUROLOGICAL SERVICES OF TEXAS, P.A.
Other - Org Name:SUSAN K. BLUE, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-335-3510
Mailing Address - Street 1:1001 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3021
Mailing Address - Country:US
Mailing Address - Phone:817-335-3510
Mailing Address - Fax:817-870-2144
Practice Address - Street 1:1001 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3021
Practice Address - Country:US
Practice Address - Phone:817-335-3510
Practice Address - Fax:817-870-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47944Medicare UPIN
00338KMedicare PIN