| NPI | 1538623525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 207T00000X Neurological Surgery | |
| 2084V0102X Psychiatry & Neurology, Vascular Neurology | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine | |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2025-10-10 |