| Indiana Neurology Specialty Care | |
|
3731 Rome Dr Suite A Lafayette IN 47905-4490 | |
| (765) 448-3040 | |
| (765) 447-0151 |
| Full Name | Indiana Neurology Specialty Care |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3731 Rome Dr, Lafayette, Indiana |
| Authorized Official Name and Position | Albert C Lee (PRESIDENT/OWNER) |
| Authorized Official Contact | 7654483040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Neurology Specialty Care Po Box 4577 Lafayette IN 47903-4577 Ph: (765) 448-3040 | Indiana Neurology Specialty Care 3731 Rome Dr Suite A Lafayette IN 47905-4490 Ph: (765) 448-3040 |
| NPI Number | 1013047042 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 04/05/2011 |
| Medicare PECOS PAC ID | 4284525023 |
|---|---|
| Medicare Enrollment ID | O20040917000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013047042 | NPI | - | NPPES |
| 200239140 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 01042481A (Indiana) | Primary |
| Provider Name | Albert C Lee |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790815322 PECOS PAC ID: 2163313909 Enrollment ID: I20111130000648 |
| Provider Name | Heather Renee Irelan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881139905 PECOS PAC ID: 0547544280 Enrollment ID: I20170710000085 |
| Provider Name | Sherry Dawn Hash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922647841 PECOS PAC ID: 2961685029 Enrollment ID: I20200122000207 |
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