MEDICARE: AMERICAN NEUROLOGICAL SPECIALISTS, LLC

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1376920421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN NEUROLOGICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	6918 GUNN HWY
Second Line	:	SUITE E
City	:	TAMPA
State	:	FL
Zip	:	33625-3853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6918 GUNN HWY
Second Line	:	SUITE E
City	:	TAMPA
State	:	FL
Zip	:	33625-3853
Country	:	US
Telephone Number	:	813-857-5630
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANTHONY T TRAVIESA
Credential	:
Telephone Number	:	813-857-5630

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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