OrganizationNeurology PaSpecialistOther Service ProvidersPractice Address4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9208(941) 764-0800PECOS EnrollmentBased on the most recent information from CMS, provider Neurology Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:30 PM.Profile DetailsProvider ID1326074857Provider TypeOrganizationFull NameNeurology PaSubpartNoEnumeration Date6/25/2006Last Updated2/22/2008Contact InformationPractice LocationPractice Address4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9208Phone(941) 764-0800Fax(941) 764-6494Mailing LocationMailing Address4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9208Phone(941) 764-0800Fax(941) 764-6494Authorized OfficialNameHolt, William A (President)Phone(941) 764-0800Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseOS5338FloridaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseME85919FloridaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseME99150FloridaCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA9101267FloridaProvider IdentifiersIDDescriptionIssuerIDCK2663DescriptionOtherIssuerRAILROAD MEDICAREFloridaID262779500DescriptionMedicaidIssuerUnlistedFlorida