Provider Demographics
NPI:1386026052
Name:WESTERN NEUROLOGICAL GROUP
Entity Type:Organization
Organization Name:WESTERN NEUROLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-557-9962
Mailing Address - Street 1:10169 S. 1160 W.
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-557-9962
Mailing Address - Fax:
Practice Address - Street 1:10169 S 1160 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8829
Practice Address - Country:US
Practice Address - Phone:801-557-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology