Basic Information
| Provider Information | |||||||||
| NPI: | 1801922018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BURLINGTON NEUROLOGY AND SLEEP CLINIC, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 S GEAR AVE STE 153 | ||||||||
| Address2: | MERCY PLAZA | ||||||||
| City: | WEST BURLINGTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526551686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3197544400 | ||||||||
| FaxNumber: | 3197544412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 S GEAR AVE STE 153 | ||||||||
| Address2: | MERCY PLAZA | ||||||||
| City: | WEST BURLINGTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526551686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3197544400 | ||||||||
| FaxNumber: | 3197544412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | JANI | ||||||||
| AuthorizedOfficialFirstName: | SADHNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3197544400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0435941 | 05 | IA | MEDICAID |