Provider Demographics
NPI:1669427860
Name:NEUROLOGY CARE CENTER, PC
Entity type:Organization
Organization Name:NEUROLOGY CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-939-7711
Mailing Address - Street 1:1911 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-0000
Mailing Address - Country:US
Mailing Address - Phone:765-939-7711
Mailing Address - Fax:765-939-1841
Practice Address - Street 1:1911 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-0000
Practice Address - Country:US
Practice Address - Phone:765-939-7711
Practice Address - Fax:765-939-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004846A2084N0400X
IN01022975A2084N0400X
IN01063768A2084N0400X
IN01050034A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200817940Medicaid
IN200817940AMedicaid
IN200212580Medicaid
IN200817940AMedicaid
IN200212580Medicaid
IN237290Medicare PIN