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General NPI Number Information
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NPI Number | 1669427860
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CARE CENTER, PC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 1911 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-0000
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Country | US
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Telephone | 765-939-7711
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Fax | 765-939-1841
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Provider Business Mailing Address
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Address Line | 1911 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-0000
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Country | US
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Telephone | 765-939-7711
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Fax | 765-939-1841
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Authorized Official
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Title or Position | PHYSICIAN ADMINISTRATOR
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Name | KELLEY J. PARNELL
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Credential | MD
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Telephone | 765-939-7711
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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 | 50004846A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01022975A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01063768A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01050034A
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License Number State | IN
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