Provider Demographics
NPI:1518127067
Name:NEUROLOGY SERVICE CORPORATION
Entity Type:Organization
Organization Name:NEUROLOGY SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-632-5155
Mailing Address - Street 1:1519 E BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5663
Mailing Address - Country:US
Mailing Address - Phone:719-632-5155
Mailing Address - Fax:
Practice Address - Street 1:1519 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5663
Practice Address - Country:US
Practice Address - Phone:719-632-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO236882084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC458568Medicare PIN