Provider Demographics
NPI:1861837924
Name:NEUROLOGY SPECIALTY CLINIC, PLLC
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALTY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-473-7035
Mailing Address - Street 1:PO BOX 970802
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-0802
Mailing Address - Country:US
Mailing Address - Phone:801-473-7035
Mailing Address - Fax:801-607-1467
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:STE 333
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-473-7035
Practice Address - Fax:801-607-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1706651205261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty