Provider Demographics
NPI:1952442451
Name:WABASH VALLEY NEUROLOGY LLC
Entity Type:Organization
Organization Name:WABASH VALLEY NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-232-8292
Mailing Address - Street 1:215 E MCCALLISTER DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4248
Mailing Address - Country:US
Mailing Address - Phone:812-232-8292
Mailing Address - Fax:812-232-3440
Practice Address - Street 1:215 E MCCALLISTER DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4248
Practice Address - Country:US
Practice Address - Phone:812-232-8292
Practice Address - Fax:812-232-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039496A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty