Healthcare Provider Details

I. General information

NPI: 1912963372
Provider Name (Legal Business Name): NEUROLOGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 1100 E
AMERICAN FORK UT
84003-2829
US

IV. Provider business mailing address

212 S 1100 E
AMERICAN FORK UT
84003-2829
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-0901
  • Fax: 801-763-0903
Mailing address:
  • Phone: 801-763-0901
  • Fax: 801-763-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARA LOUISE EARLE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 801-763-0901