Provider Demographics
NPI:1548239494
Name:NEUROSCIENCE SPECIALISTS PC
Entity type:Organization
Organization Name:NEUROSCIENCE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TECHNOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-748-3300
Mailing Address - Street 1:14100 PARKWAY COMMONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6036
Mailing Address - Country:US
Mailing Address - Phone:405-748-3300
Mailing Address - Fax:405-749-1671
Practice Address - Street 1:14100 PARKWAY COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6036
Practice Address - Country:US
Practice Address - Phone:405-748-3300
Practice Address - Fax:405-749-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCN6921OtherMEDICARE RAILROAD
OK100746190AMedicaid
OK100746190AMedicaid