Basic Information
| Provider Information | |||||||||
| NPI: | 1972859510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREST PARK NEUROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5811 E TRUMAN RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641262400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166001816 | ||||||||
| FaxNumber: | 8772741845 | ||||||||
| Practice Location | |||||||||
| Address1: | 5811 E TRUMAN RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641262400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166001816 | ||||||||
| FaxNumber: | 8772741845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | ANGELES | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8472512400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP0016X | 1116914 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) |
No ID Information.