Provider Demographics
NPI:1912963372
Name:NEUROLOGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-763-0901
Mailing Address - Street 1:212 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2829
Mailing Address - Country:US
Mailing Address - Phone:801-763-0901
Mailing Address - Fax:801-763-0903
Practice Address - Street 1:212 S 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2829
Practice Address - Country:US
Practice Address - Phone:801-763-0901
Practice Address - Fax:801-763-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119463100Medicaid
WY119463100Medicaid
WYW10154Medicare PIN