Basic Information
| Provider Information | |||||||||
| NPI: | 1689614406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR NEUROLOGICAL TREATMENT & RESEARCH, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 QUECREEK CIR | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153555510 | ||||||||
| FaxNumber: | 6153558699 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 QUECREEK CIR | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153555510 | ||||||||
| FaxNumber: | 6153558699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | RUBINOWICZ | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6153555510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | DO1145 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084N0400X | MD19415 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 10080086 | 05 | TN | MEDICAID | 130020427 | 01 | TN | RAILROAD MEDICARE | OTHER | 2148317 | 01 | TN | CIGNA | OTHER | 2177476 | 01 | TN | CIGNA | OTHER | 3042647 | 05 | TN | MEDICAID | 5430482 | 01 | TN | AETNA | OTHER | 3802609 | 05 | TN | MEDICAID | TN0101 | 05 | TN | MEDICAID | 0094864 | 01 | TN | BLUECROSS BLUESHIELD | OTHER | 3042648 | 05 | TN | MEDICAID | 01038929 | 05 | TN | MEDICAID | 10080085 | 05 | TN | MEDICAID | 6508106 | 01 | TN | CIGNA | OTHER | 130025292 | 01 | TN | RAILROAD MEDICARE | OTHER | 3039399 | 01 | TN | BLUE CROSS BLUESHIELD | OTHER | GC4522 | 01 | TN | RAILROAD MEDICARE | OTHER | TN0107 | 05 | TN | MEDICAID |