Provider Demographics
NPI:1053369678
Name:NATIONAL NEURO, LLC
Entity type:Organization
Organization Name:NATIONAL NEURO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-831-5050
Mailing Address - Street 1:2725 WATER RIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4580
Mailing Address - Country:US
Mailing Address - Phone:704-831-5050
Mailing Address - Fax:704-831-5072
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:STE 301
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-777-3748
Practice Address - Fax:865-777-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446689Medicaid
TN0446689Medicaid
TN446689Medicare Oscar/Certification