Basic Information
| Provider Information | |||||||||
| NPI: | 1972707982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR NEUROLOGICAL TREATMENT & 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: | 331 LANDRUM PL | ||||||||
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| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370436329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153555510 | ||||||||
| FaxNumber: | 6153558699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 06/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | RUBINOWICZ | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHEIF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6153335510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 3717551 | 05 | TN | MEDICAID | CG4522 | 01 | TN | RAILROAD MEDICARE | OTHER |