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Organization

IDOC VIRTUAL NEURO CRITICAL CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EVETTE LEWIS (PRACTICE MANAGER)
(503) 421-5124
Entity
Organization

Contact information

Practice address
1133 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5085
(713) 913-1422
Mailing address
4635 SOUTHWEST FWY STE 525, HOUSTON, TX 77027-7157
(713) 234-4431
(877) 712-5707

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
363LC0200X
Critical Care Medicine Nurse Practitioner

Other

Enumeration date
09/15/2020
Last updated
08/21/2024
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