Organization
ADVANCED NEUROSCIENCE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANOHER L. GURRU M.D. (OWNER)
(432) 570-9991
Entity
Organization
Contact information
Practice address
3400 ANDREWS HWY, MIDLAND, TX 79703-5100
(432) 570-9991
(432) 570-9998
Mailing address
PO BOX 4100, MIDLAND, TX 79704-4100
(432) 570-9991
(432) 570-9998
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
L2914
TX
2084N0400X
Neurology Physician
M3833
TX
2084N0600X
Clinical Neurophysiology Physician
L2914
TX
2084N0600X
Clinical Neurophysiology Physician
M3833
TX
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
L2914
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018HQ
BCBS
TX
05
—
149225801
—
TX
Enumeration date
01/29/2007
Last updated
10/08/2024
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