Provider Demographics
NPI:1548407752
Name:NEUROLOGY CLINIC LLC
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-421-3392
Mailing Address - Street 1:3101 MAIN ST
Mailing Address - Street 2:PO BOX 236
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2649
Mailing Address - Country:US
Mailing Address - Phone:620-421-3392
Mailing Address - Fax:620-421-5745
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2649
Practice Address - Country:US
Practice Address - Phone:620-421-3392
Practice Address - Fax:620-421-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04261102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100184970CMedicaid
KSG22036Medicare UPIN
KSKA1347Medicare PIN