1649468059 NPI number — GREENVILLE NEUROLOGY ASSOC, MD PA

Table of content: ANNAROSE NICOLE AUSTIN OTD (NPI 1275359804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649468059 NPI number — GREENVILLE NEUROLOGY ASSOC, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVILLE NEUROLOGY ASSOC, MD PA
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:
1649468059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 JOE RAMSEY BLVD E STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75401-7842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-450-8122
Provider Business Mailing Address Fax Number:
903-454-2785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 WARREN PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-7399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-618-0808
Provider Business Practice Location Address Fax Number:
469-200-8097
Provider Enumeration Date:
10/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ATA
Authorized Official First Name:
SHAMIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
214-618-0808

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  K7981 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1767444 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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