Provider Demographics
NPI:1679502819
Name:NEUROLOGY SPINE AND HEADACHE CENTER
Entity Type:Organization
Organization Name:NEUROLOGY SPINE AND HEADACHE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-5550
Mailing Address - Street 1:4159 N MAYO TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3211
Mailing Address - Country:US
Mailing Address - Phone:606-432-5550
Mailing Address - Fax:606-432-7212
Practice Address - Street 1:4159 N MAYO TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3211
Practice Address - Country:US
Practice Address - Phone:606-432-5550
Practice Address - Fax:606-432-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY345832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64345838Medicaid
WV9337341Medicare PIN
KY0777601Medicare ID - Type Unspecified
KY64345838Medicaid