Provider Demographics
NPI:1568460707
Name:NEUROLOGY & NEUROSURGERY ASSOCIATES OF TACOMA PLLC
Entity Type:Organization
Organization Name:NEUROLOGY & NEUROSURGERY ASSOCIATES OF TACOMA PLLC
Other - Org Name:NEUROLOGY & NEUROSURGERY ASSOCIATES OF TACOMA INC PS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HUDDLESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-403-7299
Mailing Address - Street 1:915 6TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4682
Mailing Address - Country:US
Mailing Address - Phone:253-403-7299
Mailing Address - Fax:253-403-7298
Practice Address - Street 1:915 6TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4682
Practice Address - Country:US
Practice Address - Phone:253-403-7299
Practice Address - Fax:253-403-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7809403Medicaid
WA7809403Medicaid