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General NPI Number Information
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NPI Number | 1023131745
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Entity Type | Organization
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Legal Business Name | NEUROHEALTH
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 2701 SW A AVE
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City | LAWTON
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State | OK
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Zip | 73505-7123
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Country | US
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Telephone | 580-248-1004
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Fax | 580-248-1008
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Provider Business Mailing Address
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Address Line | PO BOX 6570
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City | LAWTON
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State | OK
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Zip | 73506-0570
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Country | US
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Telephone | 580-248-1004
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Fax | 580-248-1108
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Authorized Official
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Title or Position | CREDENTIALING SPEC
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Name | DOUG MORROW
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Credential |
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Telephone | 580-475-0175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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