Provider Demographics
NPI:1578605887
Name:NEUROLOGICAL ASSOCIATES, CHARTERED
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ASHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-343-3976
Mailing Address - Street 1:3875 E OVERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-343-3976
Mailing Address - Fax:208-333-9942
Practice Address - Street 1:3875 E OVERLAND ROAD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-343-3976
Practice Address - Fax:208-333-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003621300Medicaid
ID002586000Medicaid
ID002585900Medicaid
IDC92404Medicare UPIN
1114341Medicare ID - Type Unspecified
ID003621300Medicaid
1123680Medicare ID - Type Unspecified
1142500Medicare ID - Type Unspecified
ID002585900Medicaid