Provider Demographics
NPI:1699703728
Name:NEUROLOGICAL CONSULTANTS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:NEUROLOGICAL CONSULTANTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-454-6850
Mailing Address - Street 1:2800 L ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5616
Mailing Address - Country:US
Mailing Address - Phone:916-454-6850
Mailing Address - Fax:916-454-6852
Practice Address - Street 1:2800 L ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-454-6850
Practice Address - Fax:916-454-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72178ZOtherMEDICARE GROUP NUMBER