MEDICARE: NEUROSCIENCE & PAIN INSTITUTE LLC

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	332900000X	Non-Pharmacy Dispensing Site	MD.301548	LA

General Provider Information

NPI Number	:	1790224525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSCIENCE & PAIN INSTITUTE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1784
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-1784
Country	:	US
Telephone Number	:	479-636-9702
Fax Number	:	877-427-2307

Provider Business Practice Location Address
First Line	:	309 WALNUT ST
Second Line	:	SUITE E
City	:	AMITE
State	:	LA
Zip	:	70422-2055
Country	:	US
Telephone Number	:	479-636-9702
Fax Number	:	877-427-2307

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSH SHROLL
Credential	:	MD
Telephone Number	:	479-636-9702

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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Directions to “NEUROSCIENCE & PAIN INSTITUTE LLC ” Practice Location

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