Provider Demographics
NPI:1013168087
Name:NEUROLOGY ASSOCIATES OF SOUTHERN OHIO LLC
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF SOUTHERN OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLA OSSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-867-2560
Mailing Address - Street 1:1010 CEREAL AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2784
Mailing Address - Country:US
Mailing Address - Phone:513-867-2560
Mailing Address - Fax:513-737-3389
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:STE 212
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-2560
Practice Address - Fax:513-737-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100079810Medicaid
OH2916170Medicaid
DO4383OtherRR MEDICARE
IN200948730 AMedicaid
IN200948730 BMedicaid
KY7100079810Medicaid