1689614406 NPI number — CENTER FOR NEUROLOGICAL TREATMENT & RESEARCH, PLLC

Table of content: (NPI 1689614406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689614406 NPI number — CENTER FOR NEUROLOGICAL TREATMENT & RESEARCH, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR NEUROLOGICAL TREATMENT & RESEARCH, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689614406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 QUECREEK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37167-6834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-355-5510
Provider Business Mailing Address Fax Number:
615-355-8699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 QUECREEK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37167-6834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-355-5510
Provider Business Practice Location Address Fax Number:
615-355-8699
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUBINOWICZ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
615-355-5510

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD19415 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084S0012X , with the licence number: DO1145 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10080086 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130020427 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2148317 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2177476 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3042647 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5430482 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3802609 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0101 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0094864 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3042648 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01038929 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10080085 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6508106 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 130025292 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3039399 . This is a "BLUE CROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: GC4522 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0107 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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