Provider Demographics
NPI:1922030360
Name:NEURO-EVAL, P.C.
Entity Type:Organization
Organization Name:NEURO-EVAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-677-6425
Mailing Address - Street 1:105 N PONTIAC AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3959
Mailing Address - Country:US
Mailing Address - Phone:334-677-6425
Mailing Address - Fax:334-677-6921
Practice Address - Street 1:105 N PONTIAC AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3959
Practice Address - Country:US
Practice Address - Phone:334-677-6425
Practice Address - Fax:334-677-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51089293OtherBCBS AL