Provider Demographics
NPI:1760492326
Name:WINSTON NEUROLOGY, PA
Entity Type:Organization
Organization Name:WINSTON NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOUVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-5553
Mailing Address - Street 1:1492 RYMCO DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-5553
Mailing Address - Fax:336-765-5359
Practice Address - Street 1:1492 RYMCO DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-5553
Practice Address - Fax:336-765-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2327802OtherMEDICARE ID
NC89013MXMedicaid
NC4681210001Medicare NSC
NC2327802Medicare ID - Type Unspecified