MEDICARE: TEXAS NEUROLOGICAL CLINIC ASSOCIATION

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00K442	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1558405894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS NEUROLOGICAL CLINIC ASSOCIATION

Provider Business Mailing Address
First Line	:	4126 SOUTHWEST FWY STE 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-7344
Country	:	US
Telephone Number	:	713-621-9291
Fax Number	:	713-621-0881

Provider Business Practice Location Address
First Line	:	4126 SOUTHWEST FWY STE 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-7344
Country	:	US
Telephone Number	:	713-621-9291
Fax Number	:	713-621-0881

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM JOHN RILEY
Credential	:	MD
Telephone Number	:	713-621-9291

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	10/16/2007

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