Basic Information
Provider Information
NPI: 1548239494
EntityType: 2
ReplacementNPI:  
OrganizationName: NEUROSCIENCE SPECIALISTS PC
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Mailing Information
Address1: 14100 PARKWAY COMMONS DR STE 100
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731346036
CountryCode: US
TelephoneNumber: 4057483300
FaxNumber: 4057491671
Practice Location
Address1: 14100 PARKWAY COMMONS DR STE 100
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731346036
CountryCode: US
TelephoneNumber: 4057483300
FaxNumber: 4057491671
Other Information
ProviderEnumerationDate: 03/14/2006
LastUpdateDate: 02/02/2022
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MCCOLLUM
AuthorizedOfficialFirstName: NICHOLAS
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AuthorizedOfficialTitleorPosition: DIRECTOR OF TECHNOLOGY
AuthorizedOfficialTelephone: 4057483300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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NPICertificationDate: 02/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
204C00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine 
204D00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM 
207T00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansNeurological Surgery 

ID Information
IDTypeStateIssuerDescription
CN692101OKMEDICARE RAILROADOTHER
100746190A05OK MEDICAID


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