Basic Information
| Provider Information | |||||||||
| NPI: | 1083679609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGY ASSOCIATES OF ORMOND BEACH PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 MIRROR LAKE DR | ||||||||
| Address2: | STE A | ||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321745935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866732500 | ||||||||
| FaxNumber: | 3866733204 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 MIRROR LAKE DR | ||||||||
| Address2: | STE A | ||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321745935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866732500 | ||||||||
| FaxNumber: | 3866733204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3866732500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 250638600 | 05 | FL | MEDICAID | CC7418 | 01 | FL | RAILROAD MEDICARE | OTHER | 40662 | 01 | FL | BLUE CROSS | OTHER |