Healthcare Provider Details

I. General information

NPI: 1770886392
Provider Name (Legal Business Name): VIGILANT PARTNERS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PARK DR
NEENAH WI
54956-2899
US

IV. Provider business mailing address

318 PARK DR
NEENAH WI
54956-2899
US

V. Phone/Fax

Practice location:
  • Phone: 920-284-5243
  • Fax:
Mailing address:
  • Phone: 920-284-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number42460020
License Number StateWI

VIII. Authorized Official

Name: DR. JOSEPH J JARES III
Title or Position: OWNER
Credential: MD
Phone: 920-284-5243