| Lifestyle Neurology Pc | |
|
2215 West St Ste 100 Germantown TN 38138-3874 | |
| (901) 440-8482 | |
| (901) 440-8582 |
| Full Name | Lifestyle Neurology Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2215 West St Ste 100, Germantown, Tennessee |
| Authorized Official Name and Position | John J Kelley (OPERATIONS MANAGER) |
| Authorized Official Contact | 8883251691 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestyle Neurology Pc 8777 Johannesburg Dr Germantown TN 38139-6503 Ph: (888) 325-1691 | Lifestyle Neurology Pc 2215 West St Ste 100 Germantown TN 38138-3874 Ph: (901) 440-8482 |
| NPI Number | 1497226682 |
|---|---|
| Provider Enumeration Date | 12/16/2018 |
| Last Update Date | 04/28/2019 |
| Medicare PECOS PAC ID | 6103164041 |
|---|---|
| Medicare Enrollment ID | O20190219000643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497226682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Rance B Wilbourn |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063676690 PECOS PAC ID: 4789719816 Enrollment ID: I20180719003632 |
| Provider Name | Jacqueline Michele Hafner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780279133 PECOS PAC ID: 3971993791 Enrollment ID: I20211209000199 |
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