Basic Information
| Provider Information | |||||||||
| NPI: | 1972700417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR NEUROLOGICAL TREATMENT AND RESEARCH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 STONECREST PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153555510 | ||||||||
| FaxNumber: | 6153558699 | ||||||||
| Practice Location | |||||||||
| Address1: | 254 REN MAR DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PLEASANT VIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371463722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157464533 | ||||||||
| FaxNumber: | 6157464636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | RUBINOWICZ | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6153555510 | ||||||||
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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 | 2084S0012X | DO1145 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3039399 | 01 | TN | BCBS | OTHER | 3802609 | 05 | TN | MEDICAID | TN0101 | 05 | TN | MEDICAID | CG4522 | 01 | TN | MEDICARE RR | OTHER |