Provider Demographics
NPI:1457410862
Name:VANBUREN ROSS LEMONS MD A NEUROLOGICAL MEDICAL CORP
Entity type:Organization
Organization Name:VANBUREN ROSS LEMONS MD A NEUROLOGICAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAN BUREN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:LEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-648-0144
Mailing Address - Street 1:PO BOX 742561 FILE 742561
Mailing Address - Street 2:
Mailing Address - City:LOS ANGLES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2561
Mailing Address - Country:US
Mailing Address - Phone:916-648-0144
Mailing Address - Fax:916-561-0867
Practice Address - Street 1:3415 AMERICAN RIVER DR
Practice Address - Street 2:#A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5794
Practice Address - Country:US
Practice Address - Phone:916-648-0144
Practice Address - Fax:916-561-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG609020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty