Provider Demographics
NPI:1063679595
Name:NEURO CLINICAL HOLDINGS, LLC
Entity type:Organization
Organization Name:NEURO CLINICAL HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-770-2501
Mailing Address - Street 1:5480 LBJ FREEWAY
Mailing Address - Street 2:THREE LINCOLN CENTRE SUITE 1480
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-770-2501
Mailing Address - Fax:972-770-2505
Practice Address - Street 1:5480 LBJ FREEWAY
Practice Address - Street 2:3 LINCOLN CENTRE SUITE 1480
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-770-2501
Practice Address - Fax:972-770-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies