Provider Demographics
NPI:1891902904
Name:NATIONAL NEUROPHYSIOLOGY INSTITUTE LLC
Entity Type:Organization
Organization Name:NATIONAL NEUROPHYSIOLOGY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-338-1255
Mailing Address - Street 1:12123 SHELBYVILLE RD
Mailing Address - Street 2:#302
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1345
Mailing Address - Country:US
Mailing Address - Phone:502-338-1255
Mailing Address - Fax:866-403-7977
Practice Address - Street 1:12123 SHELBYVILLE RD
Practice Address - Street 2:#302
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1345
Practice Address - Country:US
Practice Address - Phone:502-338-1255
Practice Address - Fax:866-403-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
OH35-076675305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1619148707Medicaid
KY1891902904Medicaid