Provider Demographics
NPI:1568622579
Name:THE NEUROHEALTH SCIENCE CENTER LLC DBA CHARLOTTE NEUROSURGERY
Entity Type:Organization
Organization Name:THE NEUROHEALTH SCIENCE CENTER LLC DBA CHARLOTTE NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-7920
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-629-7920
Mailing Address - Fax:941-629-7926
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:STE 208
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-629-7920
Practice Address - Fax:941-629-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty