Provider Demographics
NPI:1780877548
Name:NEUROLOGY CLINIC, INC
Entity type:Organization
Organization Name:NEUROLOGY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-5185
Mailing Address - Street 1:PO BOX 1670
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4670
Mailing Address - Country:US
Mailing Address - Phone:304-645-5185
Mailing Address - Fax:904-645-5184
Practice Address - Street 1:100 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1337
Practice Address - Country:US
Practice Address - Phone:304-645-5185
Practice Address - Fax:904-645-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV217432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC7262OtherPALMETTO GBA
DC7262OtherPALMETTO GBA
4147641Medicare PIN
WV9349271Medicare PIN