Provider Demographics
NPI:1265516207
Name:CENTRAL TEXAS NEUROLOGICAL ASSOCIATION
Entity type:Organization
Organization Name:CENTRAL TEXAS NEUROLOGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-399-9291
Mailing Address - Street 1:205 WOODHEW DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6689
Mailing Address - Country:US
Mailing Address - Phone:254-399-9291
Mailing Address - Fax:254-399-8414
Practice Address - Street 1:205 WOODHEW DR STE 110
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6689
Practice Address - Country:US
Practice Address - Phone:254-399-9291
Practice Address - Fax:254-399-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J26AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER