Provider Demographics
NPI:1417108796
Name:LONDON CORPORATON
Entity Type:Organization
Organization Name:LONDON CORPORATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:JASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-577-9467
Mailing Address - Street 1:23 SOUTH PAULINE STREET
Mailing Address - Street 2:SUITE 709
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3121
Mailing Address - Country:US
Mailing Address - Phone:901-577-9467
Mailing Address - Fax:901-362-6618
Practice Address - Street 1:23 SOUTH PAULINE STREET
Practice Address - Street 2:SUITE 709
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3121
Practice Address - Country:US
Practice Address - Phone:901-577-9467
Practice Address - Fax:901-362-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN263762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1003005885OtherNPI
TN3098864Medicaid
TN1510854Medicaid
TN3098864Medicaid
TN1510854Medicaid
TN3098864Medicare PIN
TN1003005885OtherNPI