Provider Demographics
NPI:1861547390
Name:NEUROLOGY OF TWIN FALLS, LLC
Entity type:Organization
Organization Name:NEUROLOGY OF TWIN FALLS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-737-2530
Mailing Address - Street 1:PO BOX 2790
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-2790
Mailing Address - Country:US
Mailing Address - Phone:208-737-2530
Mailing Address - Fax:208-737-2731
Practice Address - Street 1:630 ADDISON AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5491
Practice Address - Country:US
Practice Address - Phone:208-737-2530
Practice Address - Fax:208-737-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty