Provider Demographics
NPI:1346387784
Name:BERRIEN REGIONAL ASSOCIATES IN NEUROLOGY,PLLC
Entity Type:Organization
Organization Name:BERRIEN REGIONAL ASSOCIATES IN NEUROLOGY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARD
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:269-985-0000
Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-985-0000
Mailing Address - Fax:269-985-0360
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:STE 230
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-985-0000
Practice Address - Fax:269-985-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M94160Medicare ID - Type Unspecified