Organization Name: | FOREST PARK NEUROLOGY, LLC. |
NPI Number: | 1376804898 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIA LOURDES DONATO (OFFICE MANAGER) |
Mailing Address: | 3431 S State Route 291 Independence |
State: | MO US |
Postal Code: | 640572341 |
Phone Number: | 8166001816 |
Fax Number: | 8167956966 |
NPI Enumeration Date: | 05/31/2012 |
NPI Last Update Date: | 05/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 2008002407 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |