Provider Demographics
NPI:1285709469
Name:WINSTON NEUROLOGY, PA
Entity type:Organization
Organization Name:WINSTON NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAUVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-5553
Mailing Address - Street 1:2933 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4001
Mailing Address - Country:US
Mailing Address - Phone:336-765-5533
Mailing Address - Fax:336-765-5359
Practice Address - Street 1:2933 MAPLEWOOD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4001
Practice Address - Country:US
Practice Address - Phone:336-765-5533
Practice Address - Fax:336-765-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-11-05
Deactivation Date:2009-09-04
Deactivation Code:
Reactivation Date:2009-11-05
Provider Licenses
StateLicense IDTaxonomies
NC9500979332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013MXMedicaid
NC4681210001OtherPALMETTO DME #
NC89013MXMedicaid