Provider Demographics
NPI:1740349067
Name:NEUROLOGY ASSOCIATES OF ST JOSEPH INC
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF ST JOSEPH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENADHA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:DAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-279-8848
Mailing Address - Street 1:105 FAR WEST DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-279-8848
Mailing Address - Fax:816-279-0218
Practice Address - Street 1:105 FAR WEST DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-279-8848
Practice Address - Fax:816-279-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7330000Medicare ID - Type Unspecified