Provider Demographics
NPI:1790978195
Name:NEUROLOGIC SPECIALTY CONSULTING LLC
Entity Type:Organization
Organization Name:NEUROLOGIC SPECIALTY CONSULTING LLC
Other - Org Name:SOUTHWEST NEUROSCIENCE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-504-4039
Mailing Address - Street 1:802 E. FARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-504-4039
Mailing Address - Fax:337-504-4032
Practice Address - Street 1:802 E. FARREL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-504-4039
Practice Address - Fax:337-504-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019639174400000X
174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty