Provider Demographics
NPI:1265754527
Name:NEUROLOGICAL ASSOCIATES OF THE FOUR STATES
Entity type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF THE FOUR STATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-627-9595
Mailing Address - Street 1:1102 RUSTIC RDG
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3680
Mailing Address - Country:US
Mailing Address - Phone:417-627-9596
Mailing Address - Fax:
Practice Address - Street 1:3125 DR RUSSELL SMITH WAY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7402
Practice Address - Country:US
Practice Address - Phone:417-359-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100303282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital