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General NPI Number Information
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NPI Number | 1700102753
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL CARE CLINIC PC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 825 DAVIS ST SUITE D
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City | BLACKSBURG
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State | VA
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Zip | 24060-7013
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Country | US
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Telephone | 540-951-5090
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Fax | 540-552-3100
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | CHRISTIANSBURG
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State | VA
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Zip | 24068-0126
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Country | US
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Telephone | 540-951-5090
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Fax | 540-552-2500
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL MARRUFO
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Credential | M.D.
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Telephone | 540-951-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101238524
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License Number State | VA
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