Provider Demographics
NPI:1205906062
Name:NEUROSURGICAL ASSOCIATES
Entity type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-622-5325
Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-622-5325
Mailing Address - Fax:757-625-6743
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-622-5325
Practice Address - Fax:757-625-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006100350Medicaid
VA006101593Medicaid
VA006105319Medicaid
VAH20415Medicare UPIN
VAH52188Medicare UPIN
VA006101593Medicaid
VAG52109Medicare UPIN
VA140000174Medicare ID - Type Unspecified
VA006100350Medicaid