Basic Information
| Provider Information | |||||||||
| NPI: | 1184877094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH LITTLE ROCK NEUROLOGY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MERCY LN STE 503 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016230280 | ||||||||
| FaxNumber: | 5016232405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MERCY LN STE 503 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016230280 | ||||||||
| FaxNumber: | 5016232405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | PELLEGRINO | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | GUSTAVE | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 5016230280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D.,PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N7649 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.