Provider Demographics
NPI:1972633733
Name:NEUROLOGICAL AND ELECTRODIAGNOSTIC INSTITUTE OF ST. LOUIS INC.
Entity type:Organization
Organization Name:NEUROLOGICAL AND ELECTRODIAGNOSTIC INSTITUTE OF ST. LOUIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULJIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-537-0525
Mailing Address - Street 1:14825 N OUTER 40
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:636-537-0525
Mailing Address - Fax:636-537-0575
Practice Address - Street 1:14825 N OUTER 40
Practice Address - Street 2:SUITE 330
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:636-537-0525
Practice Address - Fax:636-537-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011477Medicare PIN