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General NPI Number Information
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NPI Number | 1033512322
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Entity Type | Organization
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Legal Business Name | SPECTRUM NEUROLOGY CENTER LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3409 DIVISION ST
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City | METAIRIE
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State | LA
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Zip | 70002-4611
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Country | US
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Telephone | 504-454-7246
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Fax | 504-454-3299
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Provider Business Mailing Address
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Address Line | 3409 DIVISION ST
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City | METAIRIE
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State | LA
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Zip | 70002-4611
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Country | US
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Telephone | 504-454-7246
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Fax | 504-454-3299
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. TROY BEAUCOUDRAY
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Credential | MD
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Telephone | 504-454-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 201074
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License Number State | LA
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