Provider Demographics
NPI:1598808354
Name:NEUROLOGICAL ASSOCIATES OF RUTHERFORD, PLLC
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF RUTHERFORD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-288-0880
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-0591
Mailing Address - Country:US
Mailing Address - Phone:828-288-0880
Mailing Address - Fax:828-288-1188
Practice Address - Street 1:153 W COURT ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2804
Practice Address - Country:US
Practice Address - Phone:828-288-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891139EMedicaid
NC2254845Medicare PIN