MEDICARE: NEUROLOGY ASSOCIATES OF ORMOND BEACH

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

General Provider Information

NPI Number	:	1871980631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY ASSOCIATES OF ORMOND BEACH

Provider Business Mailing Address
First Line	:	8 MIRROR LAKE DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-3101
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:	386-676-6349

Provider Business Practice Location Address
First Line	:	8 MIRROR LAKE DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-3101
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:	386-676-6349

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. ELIZABETH MITCHELL
Credential	:
Telephone Number	:	386-673-2500

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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