Provider Demographics
NPI:1548261712
Name:NEUROMEDICINE CENTER, PLLC
Entity type:Organization
Organization Name:NEUROMEDICINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTIBHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-615-7800
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 213A
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-615-7800
Mailing Address - Fax:480-615-7803
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 213A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-615-7800
Practice Address - Fax:480-615-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28930174400000X
AZ30177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0713850OtherASHOK NARAYAN, MD (BCBS)
AZ1Z0871OtherJP-HEALTHNET PROVIDER ID
AZ5085187OtherJP--AETNA PROVIDER ID
AZ691883Medicaid
AZ1Z0888OtherAN-HEALTHNET PROVIDER ID
AZ7550417OtherAN--AETNA PROVIDER ID
AZ557803Medicaid
AZAZ0881440OtherJAYANTIBHAI PATEL, MD (BC
AZ1Z0888OtherAN-HEALTHNET PROVIDER ID
AZ5085187OtherJP--AETNA PROVIDER ID
AZ70010Medicare ID - Type UnspecifiedJAYANTIBHAI PATEL, M.D.
AZ70209Medicare ID - Type UnspecifiedASHOK NARAYAN, M.D.