=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689691636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICROSURGERY AND BRAIN RESEARCH INSTITUTE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10012 KENNERLY RD STE 400
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63128-2197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-543-5999
-----------------------------------------------------
Fax | 314-543-5994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10012 KENNERLY RD STE 400
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63128-2197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-543-5999
-----------------------------------------------------
Fax | 314-543-5994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT ACCOUNTS
-----------------------------------------------------
Name | MRS. KATHY M COCHRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-543-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------