Provider Demographics
NPI:1710048467
Name:NEUROLOGIC MEDICINE, PLLC
Entity Type:Organization
Organization Name:NEUROLOGIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-742-4100
Mailing Address - Street 1:5563 S LEWIS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7141
Mailing Address - Country:US
Mailing Address - Phone:918-742-4100
Mailing Address - Fax:918-512-4846
Practice Address - Street 1:5563 S LEWIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7141
Practice Address - Country:US
Practice Address - Phone:918-742-4100
Practice Address - Fax:918-512-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522170Medicare PIN