Provider Demographics
NPI:1205892890
Name:GUILFORD NEUROLOGIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:GUILFORD NEUROLOGIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA, CMPE
Authorized Official - Phone:336-272-2511
Mailing Address - Street 1:PO BOX 29568
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-9568
Mailing Address - Country:US
Mailing Address - Phone:336-273-2511
Mailing Address - Fax:336-370-0287
Practice Address - Street 1:912 THIRD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-273-2511
Practice Address - Fax:336-370-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC041013491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205892890OtherPALMETTO GBA RR MEDICARE
NC8901685Medicaid
NC1205892890OtherPALMETTO GBA RR MEDICARE
NCE93869Medicare UPIN
NCC85220Medicare UPIN
NC230159Medicare ID - Type UnspecifiedGUILFORD NEUROLOGIC ASS
NC8901685Medicaid
NCC84487Medicare UPIN
NCE08627Medicare UPIN
NCH39136Medicare UPIN