Provider Demographics
NPI:1447240320
Name:SALEM NEUROLOGICAL CENTER, P.A.
Entity Type:Organization
Organization Name:SALEM NEUROLOGICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-661-5979
Mailing Address - Street 1:1605 WESTBROOK PLAZA DR STE 302
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2900
Mailing Address - Country:US
Mailing Address - Phone:336-760-3007
Mailing Address - Fax:336-760-9334
Practice Address - Street 1:1605 WESTBROOK PLAZA DR STE 302
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2900
Practice Address - Country:US
Practice Address - Phone:336-760-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26263174400000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0260WOtherNCBCBS
NC2317067AOtherMEDICARE PTAN
NC890260WMedicaid