Provider Demographics
NPI:1457541237
Name:KINGWOOD NEUROLOGY AND SLEEP PA
Entity Type:Organization
Organization Name:KINGWOOD NEUROLOGY AND SLEEP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-359-5981
Mailing Address - Street 1:PO BOX 9547
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9547
Mailing Address - Country:US
Mailing Address - Phone:281-359-5981
Mailing Address - Fax:281-359-3591
Practice Address - Street 1:22999 HIGHWAY 59 N BLDG B STE 416
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4412
Practice Address - Country:US
Practice Address - Phone:281-359-5981
Practice Address - Fax:281-359-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172034401Medicaid
TX00506YMedicare PIN
TXDD0999Medicare PIN