Provider Demographics
NPI:1093886749
Name:COMPREHENSIVE EPILEPSY CARE CENTER FOR CHILDREN AND ADULTS, P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE EPILEPSY CARE CENTER FOR CHILDREN AND ADULTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-453-9300
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 129 A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-453-9300
Mailing Address - Fax:314-453-0163
Practice Address - Street 1:3009 NORTH BALLAS ROAD
Practice Address - Street 2:SUITE 129A
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2381
Practice Address - Country:US
Practice Address - Phone:314-453-9300
Practice Address - Fax:314-453-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9G50174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507640605Medicaid
MO000011940Medicare ID - Type UnspecifiedGROUP ID