Provider Demographics
NPI:1407025901
Name:SHELBYVILLE NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:SHELBYVILLE NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-633-1937
Mailing Address - Street 1:720 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1685
Mailing Address - Country:US
Mailing Address - Phone:502-633-1937
Mailing Address - Fax:
Practice Address - Street 1:720 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1685
Practice Address - Country:US
Practice Address - Phone:502-633-1937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1168940OtherPASSPORT HEALTH PLAN
KY64305733Medicaid
KY000000197418OtherANTHEM BLUE CROSS
KY1168940OtherPASSPORT HEALTH PLAN
KYG66997Medicare UPIN