| West Central Neurology Pa | |
|
11521 312th Ave Princeton MN 55371-3423 | |
| (763) 389-4910 | |
| Not Available |
| Full Name | West Central Neurology Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11521 312th Ave, Princeton, Minnesota |
| Authorized Official Name and Position | Lawrence John Jedlicka (PRESIDENT) |
| Authorized Official Contact | 9072906355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Central Neurology Pa Po Box 110614 Anchorage AK 99511-0614 Ph: (763) 389-4910 | West Central Neurology Pa 11521 312th Ave Princeton MN 55371-3423 Ph: (763) 389-4910 |
| NPI Number | 1720233570 |
|---|---|
| Provider Enumeration Date | 11/20/2008 |
| Last Update Date | 11/19/2018 |
| Medicare PECOS PAC ID | 0840348496 |
|---|---|
| Medicare Enrollment ID | O20190131002003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720233570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 33547 (Minnesota) | Primary |
| Provider Name | Lawrence Jedlicka |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508958521 PECOS PAC ID: 2860492238 Enrollment ID: I20151006001044 |
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