MEDICARE: NEURAGENEX 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	207Q00000X	Family Medicine Physician
2	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1790310761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURAGENEX LLC

Provider Business Mailing Address
First Line	:	3570 S VAL VISTA DR STE 110
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 S VAL VISTA DR STE 110
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7327
Country	:	US
Telephone Number	:	480-246-7353
Fax Number	:

Authorized Official
Title or Position	:	OWNER, AUTHORIZED OFFICIAL
Name	:	TIMOTHY A HIRST
Credential	:
Telephone Number	:	480-246-7353

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	03/10/2020

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Directions to “NEURAGENEX LLC ” Practice Location

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