Provider Demographics
NPI:1740594738
Name:ADVANCED NEUROLOGIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-483-2403
Mailing Address - Street 1:5433 STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9708
Mailing Address - Country:US
Mailing Address - Phone:419-483-1203
Mailing Address - Fax:419-484-1203
Practice Address - Street 1:110 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1611
Practice Address - Country:US
Practice Address - Phone:419-483-2403
Practice Address - Fax:419-484-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2383620Medicaid
OHCL1664OtherRAILROAD MEDICARE
OH2383620Medicaid
OHAD9327871Medicare PIN