MEDICARE: CENTRAL TEXAS NEUROLOGICAL ASSOCIATION

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

General Provider Information

NPI Number	:	1265516207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TEXAS NEUROLOGICAL ASSOCIATION

Provider Business Mailing Address
First Line	:	205 WOODHEW DR STE 110
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-6689
Country	:	US
Telephone Number	:	254-399-9291
Fax Number	:	254-399-8414

Provider Business Practice Location Address
First Line	:	205 WOODHEW DR STE 110
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-6689
Country	:	US
Telephone Number	:	254-399-9291
Fax Number	:	254-399-8414

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDY C GARDELL
Credential	:	MD
Telephone Number	:	254-399-9291

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/20/2023

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