Provider Demographics
NPI:1760584577
Name:NEUROLOGY CARE, PC
Entity Type:Organization
Organization Name:NEUROLOGY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ARVO
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-5775
Mailing Address - Street 1:1115 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2354
Mailing Address - Country:US
Mailing Address - Phone:580-226-5775
Mailing Address - Fax:580-226-5743
Practice Address - Street 1:1115 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2354
Practice Address - Country:US
Practice Address - Phone:580-226-5775
Practice Address - Fax:580-226-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK231632084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23163OtherOK LICENSE #
OK548436293001OtherBCBS 12 DIGIT #
OK20003140AMedicaid
OK$$$$$$$$$OtherSSN #
OK548436293001OtherBCBS 12 DIGIT #