Basic Information
| Provider Information | |||||||||
| NPI: | 1952691396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT JOSEPH MEDICAL FOUNDATION, INC | ||||||||
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| OtherOrganizationName: | NEUROLOGY CLINIC OF LONDON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73652 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592764429 | ||||||||
| FaxNumber: | 8592765939 | ||||||||
| Practice Location | |||||||||
| Address1: | 192 LONDON SHOPPING CTR | ||||||||
| Address2: | STE 2 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407413015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068776050 | ||||||||
| FaxNumber: | 6068772136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CARMEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO/VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6063306015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.