| Centennial Neuroscience, Llc | |
|
2400 Patterson St Suite 320 Nashville TN 37203-1562 | |
| (615) 342-6840 | |
| (615) 342-6844 |
| Full Name | Centennial Neuroscience, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2400 Patterson St, Nashville, Tennessee |
| Authorized Official Name and Position | John Rodgers (VICE PRESIDENT) |
| Authorized Official Contact | 6153737600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centennial Neuroscience, Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7406 | Centennial Neuroscience, Llc 2400 Patterson St Suite 320 Nashville TN 37203-1562 Ph: (615) 342-6840 |
| NPI Number | 1104152859 |
|---|---|
| Provider Enumeration Date | 10/29/2009 |
| Last Update Date | 06/25/2024 |
| Certification Date | 06/25/2024 |
| Medicare PECOS PAC ID | 4789728445 |
|---|---|
| Medicare Enrollment ID | O20100218000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104152859 | NPI | - | NPPES |
| 4247885 | Other | TN | BCBS |
| 1515971 | Medicaid | TN | |
| DP8807 | Other | TN | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Adrian A Jarquin-valdivia |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427132521 PECOS PAC ID: 5294723136 Enrollment ID: I20040430001363 |
| Provider Name | Maria F Dongas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508854043 PECOS PAC ID: 7012940463 Enrollment ID: I20050915000639 |
| Provider Name | Corey Jeanne Leibell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326469651 PECOS PAC ID: 7618190638 Enrollment ID: I20180809004318 |
| Provider Name | Kelsey Peters |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306376652 PECOS PAC ID: 9133498306 Enrollment ID: I20220915003785 |
| Provider Name | Phaniraj Iyengar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1922186659 PECOS PAC ID: 9032219068 Enrollment ID: I20230719004328 |
| Provider Name | Tonse Ashwini Kini |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881121523 PECOS PAC ID: 5092178178 Enrollment ID: I20230823002375 |
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