Provider Demographics
NPI:1225261357
Name:NEUROLOGICAL CONSULTANTS OF CAPE GIRARDEAU, L.L.C.
Entity Type:Organization
Organization Name:NEUROLOGICAL CONSULTANTS OF CAPE GIRARDEAU, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-334-4110
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1118
Mailing Address - Country:US
Mailing Address - Phone:573-334-4110
Mailing Address - Fax:573-335-4178
Practice Address - Street 1:63 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:573-334-4110
Practice Address - Fax:573-334-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR64552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty