1760092142 NPI number — NEUROLOGY PSYCHIATRY AND SLEEP DISORDER CLINIC PLLC

Table of content: (NPI 1760092142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760092142 NPI number — NEUROLOGY PSYCHIATRY AND SLEEP DISORDER CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY PSYCHIATRY AND SLEEP DISORDER CLINIC PLLC
Provider Last Name:
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Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1760092142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2508 SAM SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-1492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-918-7399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 W 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSETT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71635-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-918-7399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
501-223-2776

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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