=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689781965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWER NEUROLOGICAL SERVICES, MEDICAL CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 02/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8700 BEVERLY BLVD
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-659-1498
-----------------------------------------------------
Fax | 310-659-1528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7135 HOLLYWOOD BLVD SUITE 1206
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90046-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-659-1498
-----------------------------------------------------
Fax | 310-659-1528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. CAMERON RUSSELL ADAMS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-659-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0600X
-----------------------------------------------------
Taxonomy Name | Clinical Neurophysiology Physician
-----------------------------------------------------
License Number | G82192
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | G82192
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------