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NPI Code Detail

MEDICARE: NEON CLINIC, INC

MEDICARE: NEON CLINIC, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1215980131
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEON CLINIC, INC
Provider Business Mailing Address
First Line : PO BOX 15268
Second Line :
City : ASHEVILLE
State : NC
Zip : 28813-0268
Country : US
Telephone Number : 828-250-2835
Fax Number :
Provider Business Practice Location Address
First Line : 1301 LINCOLN RD
Second Line :
City : IDABEL
State : OK
Zip : 74745-7300
Country : US
Telephone Number : 580-208-3121
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : AMY FORD
Credential :
Telephone Number : 903-640-7317
Provider Enumeration Date : 05/19/2006
Last Update Date : 08/22/2020

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Directions to “NEON CLINIC, INC ” Practice Location

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