Provider Demographics
NPI:1962844043
Name:RURAL NEUROLOGY FOUNDATION
Entity Type:Organization
Organization Name:RURAL NEUROLOGY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST, CET
Authorized Official - Phone:321-527-1178
Mailing Address - Street 1:230 COUNTRY LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5020
Mailing Address - Country:US
Mailing Address - Phone:321-527-1178
Mailing Address - Fax:407-703-5541
Practice Address - Street 1:230 COUNTRY LANDING BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5020
Practice Address - Country:US
Practice Address - Phone:321-527-1178
Practice Address - Fax:407-703-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT-NONPROFIT261QM1300X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic