Provider Demographics
NPI:1770577579
Name:NEUROLOGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-6520
Mailing Address - Street 1:500 WEST BROADWAY STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4012
Mailing Address - Country:US
Mailing Address - Phone:406-728-6520
Mailing Address - Fax:
Practice Address - Street 1:500 WEST BROADWAY STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4012
Practice Address - Country:US
Practice Address - Phone:406-728-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE8579OtherRAILROAD MEDICARE
MT27T5427OtherBLUE CROSS BLUE SHIELD
WA7316805Medicaid
WA7316805Medicaid