Provider Demographics
NPI:1437443934
Name:INGHAM NEUROSCIENCE GROUP LLC
Entity Type:Organization
Organization Name:INGHAM NEUROSCIENCE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:INGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-227-6947
Mailing Address - Street 1:2940 S JONES BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5630
Mailing Address - Country:US
Mailing Address - Phone:702-227-6947
Mailing Address - Fax:702-247-4319
Practice Address - Street 1:2940 S JONES BLVD STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5630
Practice Address - Country:US
Practice Address - Phone:702-227-6947
Practice Address - Fax:702-247-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10462208100000X
NV88042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty