Provider Demographics
NPI:1548313034
Name:NEUROLOGY & SLEEP CLINIC A PROFESSIONAL MEDICAL CORP
Entity type:Organization
Organization Name:NEUROLOGY & SLEEP CLINIC A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOUFARREJ
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:318-797-1585
Mailing Address - Street 1:2205 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5308
Mailing Address - Country:US
Mailing Address - Phone:318-797-1585
Mailing Address - Fax:318-797-6077
Practice Address - Street 1:2205 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5308
Practice Address - Country:US
Practice Address - Phone:318-797-1585
Practice Address - Fax:318-797-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========0OtherBLUE CROSS PROVIDER NO.
LA=========OtherTRICARE
LA=========0OtherBLUE CROSS PROVIDER NO.