Provider Demographics
NPI:1336686286
Name:GREYSTONE NEUROLOGY AND PAIN CENTERS, INC.
Entity Type:Organization
Organization Name:GREYSTONE NEUROLOGY AND PAIN CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-991-3300
Mailing Address - Street 1:7500 HUGH DANIEL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7148
Mailing Address - Country:US
Mailing Address - Phone:205-991-3300
Mailing Address - Fax:205-991-3327
Practice Address - Street 1:234 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2526
Practice Address - Country:US
Practice Address - Phone:256-249-5500
Practice Address - Fax:256-249-5506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREYSTONE NEUROLOGY AND PAIN CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14336261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C78902Medicare UPIN
ALC74452Medicare UPIN