Provider Demographics
NPI:1255522009
Name:MIDWEST NEUROSCIENCE PC
Entity type:Organization
Organization Name:MIDWEST NEUROSCIENCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONOHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-373-3213
Mailing Address - Street 1:17020 E 40 HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5365
Mailing Address - Country:US
Mailing Address - Phone:816-373-3213
Mailing Address - Fax:816-373-6209
Practice Address - Street 1:17020 E 40 HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5365
Practice Address - Country:US
Practice Address - Phone:816-373-3213
Practice Address - Fax:816-373-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR7396OtherLICENSE NUMBNER
MO209250703Medicaid
MOR7396OtherLICENSE NUMBNER