Provider Demographics
NPI:1841361623
Name:NEUROLOGICAL SURGERY OF BELLEVILLE
Entity type:Organization
Organization Name:NEUROLOGICAL SURGERY OF BELLEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-3330
Mailing Address - Street 1:340 WEST LINCOLN STREET
Mailing Address - Street 2:SUITE 540
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220
Mailing Address - Country:US
Mailing Address - Phone:618-233-3330
Mailing Address - Fax:618-233-3170
Practice Address - Street 1:340 WEST LINCOLN STREET
Practice Address - Street 2:SUITE 540
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220
Practice Address - Country:US
Practice Address - Phone:618-233-3330
Practice Address - Fax:618-233-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0336020691207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8232111OtherBLUE CROSS BLUE SHIELD
C37073Medicare UPIN
IL8232111OtherBLUE CROSS BLUE SHIELD