Provider Demographics
NPI:1548420755
Name:NEUROLOGIC CARE OF SPARTANBURG PA
Entity Type:Organization
Organization Name:NEUROLOGIC CARE OF SPARTANBURG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-582-2000
Mailing Address - Street 1:123 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1017
Mailing Address - Country:US
Mailing Address - Phone:864-582-2000
Mailing Address - Fax:864-327-9221
Practice Address - Street 1:123 DILLON DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1017
Practice Address - Country:US
Practice Address - Phone:864-582-2000
Practice Address - Fax:864-327-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCM.D. 148262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6989Medicare PIN