MEDICARE: SUN CITY NEUROLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	L2280	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164420832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN CITY NEUROLOGY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 13085
Second Line	:	CORONADO STATION
City	:	EL PASO
State	:	TX
Zip	:	79913-3085
Country	:	US
Telephone Number	:	915-592-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 N VIRGINIA ST
Second Line	:	SUITE 215
City	:	EL PASO
State	:	TX
Zip	:	79902-5300
Country	:	US
Telephone Number	:	915-592-7500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN GLUSMAN
Credential	:	M.D.
Telephone Number	:	915-592-7500

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/29/2014

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