Provider Demographics
NPI:1649777954
Name:ARCH NEUROSURGERY, LLC
Entity Type:Organization
Organization Name:ARCH NEUROSURGERY, LLC
Other - Org Name:ARCH NEUROSURGERY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-973-2955
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 754
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1207
Mailing Address - Country:US
Mailing Address - Phone:314-973-2955
Mailing Address - Fax:833-244-1845
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 754
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1207
Practice Address - Country:US
Practice Address - Phone:314-732-9559
Practice Address - Fax:833-244-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014039596207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty