MEDICARE: TRI-CITY NEUROLOGY

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
1	261QM2500X	Medical Specialty Clinic/Center	25571	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437384732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY NEUROLOGY

Provider Business Mailing Address
First Line	:	200 BATTLE ST E
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BATTLE ST E
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2420
Country	:	US
Telephone Number	:	256-493-0349
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FAZAL RAHIM
Credential	:	MD
Telephone Number	:	256-493-0349

Provider Enumeration Date	:	05/16/2009
Last Update Date	:	05/16/2009

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Directions to “TRI-CITY NEUROLOGY ” Practice Location

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