Provider Demographics
NPI:1689606097
Name:NEUROLOGY & SLEEP CENTER, P.A.
Entity Type:Organization
Organization Name:NEUROLOGY & SLEEP CENTER, P.A.
Other - Org Name:NEUROLOGY ASSOCIATES OF CAROLINAS, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:URVI
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-847-1641
Mailing Address - Street 1:1220 MANN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-847-1641
Mailing Address - Fax:704-847-1642
Practice Address - Street 1:1220 MANN DRIVE
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-847-1641
Practice Address - Fax:704-847-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2271318C174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4186Medicaid
NC1193QOtherBLUECROSS BLUESHIELD NC
NC89128FUMedicaid
SCGP4186Medicaid
NC1193QOtherBLUECROSS BLUESHIELD NC
NC89128FUMedicaid