Healthcare Provider Details

I. General information

NPI: 1730652785
Provider Name (Legal Business Name): ZIA NEUROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 PARK ST
BOWLING GREEN KY
42101-1765
US

IV. Provider business mailing address

523 PARK ST
BOWLING GREEN KY
42101-1765
US

V. Phone/Fax

Practice location:
  • Phone: 270-393-8418
  • Fax:
Mailing address:
  • Phone: 270-393-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOYCE YOUNG
Title or Position: BILLING SPECIALIST
Credential:
Phone: 270-393-8418