=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346387784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERRIEN REGIONAL ASSOCIATES IN NEUROLOGY,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3950 HOLLYWOOD RD STE 230
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-9159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-985-0000
-----------------------------------------------------
Fax | 269-985-0360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3950 HOLLYWOOD RD SUITE 230
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-9159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-985-0000
-----------------------------------------------------
Fax | 269-985-0360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. ROBERT C WARD III
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 269-985-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------