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General NPI Number Information
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NPI Number | 1003281577
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Entity Type | Organization
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Legal Business Name | NEUROSCIENCE CENTER OF THE SOUTH
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 76 STARBRUSH CIR
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City | COVINGTON
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State | LA
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Zip | 70433-7208
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Country | US
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Telephone | 985-892-8934
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Fax | 985-871-8109
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Provider Business Mailing Address
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Address Line | 76 STARBRUSH CIR
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City | COVINGTON
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State | LA
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Zip | 70433-7208
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Country | US
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Telephone | 985-892-8934
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Fax | 985-871-8109
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CHAD DOMANGUE
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Credential | M.D
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Telephone | 985-801-0575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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