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NPI Code Detail

MEDICARE: ADVANCED NEUROLOGIC ASSOCIATES, INC

MEDICARE: ADVANCED NEUROLOGIC ASSOCIATES, 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
1225100000XPhysical Therapist
22084N0400XNeurology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CL1664OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740362755
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED NEUROLOGIC ASSOCIATES, INC
Provider Business Mailing Address
First Line : 5433 STATE ROUTE 113
Second Line :
City : BELLEVUE
State : OH
Zip : 44811-9708
Country : US
Telephone Number : 419-483-2403
Fax Number : 419-483-8418
Provider Business Practice Location Address
First Line : 5433 STATE ROUTE 113
Second Line :
City : BELLEVUE
State : OH
Zip : 44811-9708
Country : US
Telephone Number : 419-483-2403
Fax Number : 419-483-8418
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : PAT MCNEA
Credential :
Telephone Number : 419-483-2403
Provider Enumeration Date : 10/19/2006
Last Update Date : 05/31/2013

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