Provider Demographics
NPI:1447478169
Name:NEUROHELATH CENTER PLLC
Entity type:Organization
Organization Name:NEUROHELATH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULIPAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-757-7056
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-1432
Mailing Address - Country:US
Mailing Address - Phone:903-757-7056
Mailing Address - Fax:903-757-7260
Practice Address - Street 1:713 N 4TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5412
Practice Address - Country:US
Practice Address - Phone:903-757-7056
Practice Address - Fax:903-757-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL46602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152867101Medicaid
TX152867101Medicaid