Provider Demographics
NPI:1821444357
Name:CENTRAL NEUROLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANSING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-2245
Mailing Address - Street 1:7500 N DREAMY DRAW DR
Mailing Address - Street 2:STE. #133
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4660
Mailing Address - Country:US
Mailing Address - Phone:602-277-2245
Mailing Address - Fax:602-265-9494
Practice Address - Street 1:7500 N DREAMY DRAW DR
Practice Address - Street 2:STE. #133
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4660
Practice Address - Country:US
Practice Address - Phone:602-277-2245
Practice Address - Fax:602-265-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24546261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG38193Medicare UPIN