Provider Demographics
NPI:1447206537
Name:ALEXANDRIA NEUROSURGICAL CLINIC INC
Entity Type:Organization
Organization Name:ALEXANDRIA NEUROSURGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DRERUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-4576
Mailing Address - Street 1:3704 NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3606
Mailing Address - Country:US
Mailing Address - Phone:318-443-4576
Mailing Address - Fax:318-449-5579
Practice Address - Street 1:3704 NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3606
Practice Address - Country:US
Practice Address - Phone:318-443-4576
Practice Address - Fax:318-449-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1792535Medicaid
LA1792535Medicaid
LA0867910001Medicare NSC
LACT1911Medicare PIN