Provider Demographics
NPI:1922298728
Name:MS NEUROSCIENCE CENTER
Entity Type:Organization
Organization Name:MS NEUROSCIENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-3102
Mailing Address - Street 1:731 S PEAR ORCHARD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4800
Mailing Address - Country:US
Mailing Address - Phone:601-952-0015
Mailing Address - Fax:601-952-1338
Practice Address - Street 1:731 S PEAR ORCHARD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4800
Practice Address - Country:US
Practice Address - Phone:601-952-0015
Practice Address - Fax:601-952-1338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER OAKS MANAGEMENT COMPANY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02454Medicare PIN