Provider Demographics
NPI:1609995489
Name:NEUROPHYSIOLOGY CENTER P.A.
Entity Type:Organization
Organization Name:NEUROPHYSIOLOGY CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-653-2775
Mailing Address - Street 1:401 N PARSONS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4538
Mailing Address - Country:US
Mailing Address - Phone:813-653-2775
Mailing Address - Fax:813-653-4521
Practice Address - Street 1:401 N PARSONS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4538
Practice Address - Country:US
Practice Address - Phone:813-653-2775
Practice Address - Fax:813-653-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03824ZMedicare ID - Type Unspecified