Provider Demographics
NPI:1528197712
Name:NEUROLOGY ASSOCIATES OF SOUTHEAST TEXAS, P.L.L.C.
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF SOUTHEAST TEXAS, P.L.L.C.
Other - Org Name:MARWAN PURGHOL, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM, CMC
Authorized Official - Phone:409-729-6700
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-1283
Mailing Address - Country:US
Mailing Address - Phone:409-729-6700
Mailing Address - Fax:409-729-6705
Practice Address - Street 1:2001 9TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2701
Practice Address - Country:US
Practice Address - Phone:409-729-6700
Practice Address - Fax:409-729-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL05202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004MGOtherBC
TX047623603Medicaid
TX8R7190OtherBC
TXL0520OtherTEXAS MEDICAL LICENSE
TX174447601Medicaid
TX0004MGOtherBC
TXL0520OtherTEXAS MEDICAL LICENSE