Provider Demographics
NPI:1588855837
Name:NEUROLOGICAL CARE CENTER OF MONTGOMERY PC
Entity Type:Organization
Organization Name:NEUROLOGICAL CARE CENTER OF MONTGOMERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-262-1113
Mailing Address - Street 1:1315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1132
Mailing Address - Country:US
Mailing Address - Phone:334-262-1113
Mailing Address - Fax:334-262-5737
Practice Address - Street 1:1315 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1132
Practice Address - Country:US
Practice Address - Phone:334-262-1113
Practice Address - Fax:334-262-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51097992OtherBCBS
ALI322Medicare PIN