| Movement Disorders Center Of Arizona Llc | |
|
13945 W Grand Ave Suite 102 Surprise AZ 85374-2437 | |
| (480) 526-5441 | |
| (480) 526-5443 |
| Full Name | Movement Disorders Center Of Arizona Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 13945 W Grand Ave, Surprise, Arizona |
| Authorized Official Name and Position | Virgilio Gerald Hilario Evidente (SOLE MEMBER) |
| Authorized Official Contact | 4805265449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Movement Disorders Center Of Arizona Llc 10635 N 140th Way Scottsdale AZ 85259-5500 Ph: (480) 526-5449 | Movement Disorders Center Of Arizona Llc 13945 W Grand Ave Suite 102 Surprise AZ 85374-2437 Ph: (480) 526-5441 |
| NPI Number | 1295050409 |
|---|---|
| Provider Enumeration Date | 03/30/2010 |
| Last Update Date | 05/02/2012 |
| Medicare PECOS PAC ID | 4688830300 |
|---|---|
| Medicare Enrollment ID | O20120725000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295050409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Virgilio Gerald H Evidente |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730163353 PECOS PAC ID: 6507907771 Enrollment ID: I20100111000040 |
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