Provider Demographics
NPI:1184877094
Name:NORTH LITTLE ROCK NEUROLOGY SERVICES
Entity type:Organization
Organization Name:NORTH LITTLE ROCK NEUROLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GUSTAVE
Authorized Official - Last Name:PELLEGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:501-623-0280
Mailing Address - Street 1:1 MERCY LN STE 503
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6462
Mailing Address - Country:US
Mailing Address - Phone:501-623-0280
Mailing Address - Fax:501-623-2405
Practice Address - Street 1:1 MERCY LN STE 503
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6462
Practice Address - Country:US
Practice Address - Phone:501-623-0280
Practice Address - Fax:501-623-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE10471Medicare UPIN