Healthcare Provider Details

I. General information

NPI: 1043670532
Provider Name (Legal Business Name): MCGREEVY NEUROHEALTH PALM COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PINNACLES DR SUITE 700
PALM COAST FL
32164-2323
US

IV. Provider business mailing address

559 W TWINCOURT TRL SUITE 607
ST AUGUSTINE FL
32095-8805
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-3006
  • Fax: 904-217-7114
Mailing address:
  • Phone: 904-230-3006
  • Fax: 904-217-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME109028
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME109028
License Number StateFL

VIII. Authorized Official

Name: MR. KAI MCGREEVY
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 904-230-3006