Basic Information
| Provider Information | |||||||||
| NPI: | 1861461436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGY CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 E 56TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633832667 | ||||||||
| FaxNumber: | 5633832672 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 E 56TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633832667 | ||||||||
| FaxNumber: | 5633832672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHARP | ||||||||
| AuthorizedOfficialFirstName: | JERRI | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5633832667 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | 0219014 | 05 | IA | MEDICAID | 21901 | 01 | WELLMARK BCBS | OTHER | CP8140 | 01 | RAILROAD MEDICARE | OTHER |