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General NPI Number Information
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NPI Number | 1548313034
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Entity Type | Organization
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Legal Business Name | NEUROLOGY & SLEEP CLINIC A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 2205 E 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71105-5308
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Country | US
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Telephone | 318-797-1585
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Fax | 318-797-6077
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Provider Business Mailing Address
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Address Line | 2205 E 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71105-5308
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Country | US
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Telephone | 318-797-1585
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Fax | 318-797-6077
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NABIL A MOUFARREJ IV
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Credential | MD
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Telephone | 318-797-1585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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