Provider Demographics
NPI:1386021194
Name:PREMIER NEUROLOGICS LLC
Entity Type:Organization
Organization Name:PREMIER NEUROLOGICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-333-1300
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3860
Mailing Address - Country:US
Mailing Address - Phone:281-333-1300
Mailing Address - Fax:281-333-1303
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3860
Practice Address - Country:US
Practice Address - Phone:281-333-1300
Practice Address - Fax:281-333-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2187208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherIRS EMPLOYER ID NUMBER