Provider Demographics
NPI:1972540524
Name:NORTHLAND NEUROLOGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NORTHLAND NEUROLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-472-5157
Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-472-5157
Mailing Address - Fax:816-472-7201
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 500
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-472-5157
Practice Address - Fax:816-472-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506664804Medicaid
MO1972540524OtherNPI
KS509500OtherBLUE SHIELD
MO15564011OtherBLUE SHIELD
KS509500OtherBLUE SHIELD
MO506664804Medicaid