Basic Information
| Provider Information | |||||||||
| NPI: | 1023005394 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OHIO VALLEY NEUROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15037 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477160037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124921960 | ||||||||
| FaxNumber: | 8124797865 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708256601 | ||||||||
| FaxNumber: | 2708257352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | MUFTI | ||||||||
| AuthorizedOfficialFirstName: | NAGHMA | ||||||||
| AuthorizedOfficialMiddleName: | SHIREEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8124921960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 7100062150 | 05 | KY | MEDICAID | 200495640 | 05 | IN | MEDICAID |