WEST CENTRAL NEUROLOGY PA (NPI# 1720233570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720233570 |
| Entity Type | Organization |
| Organization Name | WEST CENTRAL NEUROLOGY PA |
| Practice Address |
11521 312th Ave Princeton MN 55371-3423 |
| Mailing Address |
Po Box 110614 Anchorage AK 99511-0614 |
| Practice Telephone | 7633894910 |
| Mailing Telephone | 7633894910 |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2018-11-19 |
| Authorized Official Name | LAWRENCE JOHN JEDLICKA (PRESIDENT) |
| Authorized Official Telephone | 9072906355 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
33547 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
11521 312TH AVE |
| City | PRINCETON |
| State | MN |
| Zip Code | 55371-3423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053962530 | Monica Gail Broten | Technician | 30840 Tiger Street Nw, Princeton, MN 55371 | 2019-09-25 |
| 1215349584 | Stephen Destefano | Pharmacist | 31419 131st Street, Princeton, MN 55371 | 2014-05-21 |
| 1164798948 | Andrew Sudbeck | Counselor | 101 18th Avenue North, Princeton, MN 55371 | 2012-03-27 |
| 1073804803 | Sterling Pointe Senior Living LLC | Assisted Living Facility | 1250 Northland Drive, Princeton, MN 55371 | 2011-04-27 |
| 1568752533 | Rum River Health Services, Inc. | Substance Abuse Rehabilitation Facility | 3079 90th Avenue, Princeton, MN 55371 | 2011-04-12 |
| 1780989038 | Dr. Kynan Westermeyer, Dds, Pllc | Clinic/Center | 404 1st St. N, Princeton, MN 55371 | 2011-01-18 |
| 1275788085 | Cody James Leff | Pharmacist | 1100 11th Avenue South, Princeton, MN 55371 | 2008-11-20 |
| 1164679213 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1101 N 5th St, Princeton, MN 55371 | 2008-08-20 |
| 1801059639 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1506 1st Street, Princeton, MN 55371 | 2008-07-02 |
| 1497940928 | James Michael Mandt | Pharmacist | 911 Northland Drive, Fairview Northland Medical Center, Princeton, MN 55371 | 2007-09-07 |
| Find all providers in zip 55371 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194884239 | Karyl Norcross Mehlman | Psychiatry & Neurology | 7 Bouvant Dr, Princeton, NJ 08540-1208 | 2006-12-06 |
| 1699797456 | Tahir I Rana | Psychiatry & Neurology | 100 New Hope Road, 109 Medical Arts Clinic, Princeton, WV 24740 | 2006-07-24 |
| 1689636821 | William A Merva | Psychiatry & Neurology | 508 New Hope Rd Ste 7, Princeton, WV 24740-2265 | 2006-04-04 |
| 1518954080 | Vijay Maggio | Psychiatry & Neurology | 55 Winfield Rd, Princeton, NJ 08540-2431 | 2005-09-30 |
| 1275857427 | Premier Medical and Sports Rehabilitation LLC | Psychiatry & Neurology | 121 Main St, Princeton, NJ 08540-5755 | 2010-03-17 |
| 1912146812 | John Vester Md Pa | Psychiatry & Neurology | 1000 Herrontown Rd, Princeton, NJ 08540-7716 | 2009-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851905251 | Nexus | Psychiatry & Neurology | 2121 Campus Dr Se, Rochester, MN 55904-4744 | 2020-09-02 |
| 1669995528 | Malik Ghannam | Psychiatry & Neurology | 701 15th Ave Se, Minneapolis, MN 55414-4047 | 2017-07-24 |
| 1477903995 | James Albert Zeese Jr. | Psychiatry & Neurology | 2401 Laurel Avenue, Minneapolis, MN 55405 | 2016-06-15 |
| 1265790414 | Brian Michael Krasnow | Psychiatry & Neurology | 1746 Hillcrest Avenue, Saint Paul, MN 55116-2151 | 2012-04-25 |
| 1699079533 | Gilbert Westreich | Psychiatry & Neurology | 1779 Emerson Ave South, Minneapolis, MN 55403-2909 | 2011-01-07 |
| 1235388521 | Donald W Klass | Psychiatry & Neurology | 956 14th Ave Sw, Rochester, MN 55902-2078 | 2008-09-11 |
| 1598929267 | Frank Wilson Sharbrough IIi | Psychiatry & Neurology | 814 8th Ave Sw, Rochester, MN 55902-6308 | 2008-07-11 |
| 1881855187 | Kenneth James Shea IIi | Psychiatry & Neurology | 3540 17th Ave S, Saint Cloud, MN 56301-9664 | 2008-06-19 |
| 1275792293 | Ali Emami | Psychiatry & Neurology | 310 Smith Ave N Ste 440, Saint Paul, MN 55102-2316 | 2008-06-05 |
| 1174718027 | Roberta Ruth Hallquist | Psychiatry & Neurology | 2812 E Superior St, Duluth, MN 55812-2345 | 2007-09-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.