MEDICARE: COOKEVILLE 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	174400000X	Specialist

General Provider Information

NPI Number	:	1831129717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOKEVILLE NEUROLOGY

Provider Business Mailing Address
First Line	:	145 W 4TH ST
Second Line	:	SUITE 202
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2447
Country	:	US
Telephone Number	:	931-528-5633
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 W 4TH ST
Second Line	:	SUITE 202
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2447
Country	:	US
Telephone Number	:	931-528-5633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THUY T NGO
Credential	:	MD
Telephone Number	:	931-528-5633

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/08/2008

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