Centennial Neurology, PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

CENTENNIAL NEUROLOGY, PLLC

Practice address

7251 W 20TH St Unit C
Greeley, CO 80634-4626

Phone

(970) 356-3876

Fax

(970) 353-8810

NPI assigned

Aug 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David L Ewing, MD

Title

Owner

Phone

(970) 356-3876

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1205940871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7251 W 20TH ST UNIT C",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806344626",
            "telephone_number": "970-356-3876",
            "fax_number": "970-353-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7251 W 20TH ST UNIT C",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806344626",
            "telephone_number": "970-356-3876",
            "fax_number": "970-353-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL NEUROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "EWING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-356-3876",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "72735538",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.