Organization
MINNESOTA NEUROLOGIC EVALUATIONS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JYL R DINVILLE CCS-P (PHYSICIAN REIMBURSEMENT SPECIALIST)
(402) 397-5462
Entity
Organization
Contact information
Practice address
5355 320TH ST, CUSHING, MN 56443-2128
(218) 575-2097
Mailing address
PO BOX 27015, OMAHA, NE 68127-0015
(402) 393-9459
(402) 397-9895
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
15205
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27T35MI
BCBS GROUP #
MN
01
—
27T36GA
BCBS PIN
MN
05
—
663270000
—
MN
Enumeration date
03/28/2007
Last updated
10/14/2008
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