Provider Demographics
NPI:1770509234
Name:CENTER FOR NEUROLOGICAL DISORDERS, PA
Entity type:Organization
Organization Name:CENTER FOR NEUROLOGICAL DISORDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CRAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-0551
Mailing Address - Street 1:1000 HOUSTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-6415
Mailing Address - Country:US
Mailing Address - Phone:817-336-0551
Mailing Address - Fax:888-316-3855
Practice Address - Street 1:1000 HOUSTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6415
Practice Address - Country:US
Practice Address - Phone:817-336-0551
Practice Address - Fax:888-316-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000N50N0Medicaid
TX7329650001Medicare NSC
TX00N50NMedicare PIN