MEDICARE: NEUROLOGIC, 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1699100933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGIC, LLC

Provider Business Mailing Address
First Line	:	10940 S PARKER RD STE 503
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-7440
Country	:	US
Telephone Number	:	877-446-4945
Fax Number	:	866-897-0799

Provider Business Practice Location Address
First Line	:	10940 S PARKER RD STE 503
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-7440
Country	:	US
Telephone Number	:	877-446-4945
Fax Number	:	866-897-0799

Authorized Official
Title or Position	:	COO
Name	:	GLENN OREMUS
Credential	:
Telephone Number	:	303-888-4384

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	03/04/2024

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