Provider Demographics
NPI:1770801417
Name:NEUROLOGY CARE ASSOCIATES,PA
Entity type:Organization
Organization Name:NEUROLOGY CARE ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDENHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-739-2252
Mailing Address - Street 1:2655 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-3444
Mailing Address - Country:US
Mailing Address - Phone:903-784-1593
Mailing Address - Fax:903-784-6807
Practice Address - Street 1:2655 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3444
Practice Address - Country:US
Practice Address - Phone:903-784-1593
Practice Address - Fax:903-784-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP98975K15Medicaid
TXP98975K15Medicaid