Provider Demographics
NPI:1558543199
Name:GEORGETOWN NEUROLOGY PA
Entity Type:Organization
Organization Name:GEORGETOWN NEUROLOGY PA
Other - Org Name:THE NEUROSCIENCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-259-8880
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-0819
Mailing Address - Country:US
Mailing Address - Phone:512-259-8880
Mailing Address - Fax:512-259-6555
Practice Address - Street 1:11901 W PARMER LN
Practice Address - Street 2:STE 300
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7654
Practice Address - Country:US
Practice Address - Phone:512-259-8880
Practice Address - Fax:512-259-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH98702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152087601Medicaid
TX00683ROtherBCBS
TX152087601Medicaid