Provider Demographics
NPI:1689997561
Name:NORTHLAKE NEUROLOGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:NORTHLAKE NEUROLOGICAL INSTITUTE LLC
Other - Org Name:D/B/A NEUROLOGY CLINIC, EMG & EEG LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-882-4500
Mailing Address - Street 1:64301 HIGHWAY 434
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5411
Mailing Address - Country:US
Mailing Address - Phone:985-882-4500
Mailing Address - Fax:
Practice Address - Street 1:64301 HIGHWAY 434
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-5411
Practice Address - Country:US
Practice Address - Phone:985-882-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6686270001Medicare NSC