Provider Demographics
NPI:1720009681
Name:RA NEUROLOGICAL, P.C.
Entity Type:Organization
Organization Name:RA NEUROLOGICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:VALENSON
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-697-1601
Mailing Address - Street 1:11930 ARBOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2998
Mailing Address - Country:US
Mailing Address - Phone:402-697-1601
Mailing Address - Fax:402-697-5007
Practice Address - Street 1:11930 ARBOR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2998
Practice Address - Country:US
Practice Address - Phone:402-697-1601
Practice Address - Fax:402-697-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE164752084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16475OtherSTATE LICENSE NUMBER
IA0984229OtherSTATE LICENSE NUMBER
88904ANMedicare ID - Type Unspecified
IA0984229OtherSTATE LICENSE NUMBER