Provider Demographics
NPI:1558405894
Name:TEXAS NEUROLOGICAL CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:TEXAS NEUROLOGICAL CLINIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-621-9291
Mailing Address - Street 1:4126 SOUTHWEST FWY STE 1210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7344
Mailing Address - Country:US
Mailing Address - Phone:713-621-9291
Mailing Address - Fax:713-621-0881
Practice Address - Street 1:4126 SOUTHWEST FWY STE 1210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7344
Practice Address - Country:US
Practice Address - Phone:713-621-9291
Practice Address - Fax:713-621-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K442OtherBLUE CROSS
TX00K442Medicare PIN