Organization
ALBANNA NEUROSURGICAL CONSULTANTS A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRIS KETCHERSIDE CMM (PRACTICE ADM CORP SEC)
(314) 849-9090
Entity
Organization
Contact information
Practice address
5000 CEDAR PLAZA PKWY, SUITE 220, ST LOUIS, MO 63128
(314) 849-9090
(314) 849-4165
Mailing address
5000 CEDAR PLAZA PKWY, SUITE 220, ST LOUIS, MO 63128
(314) 849-9090
(314) 849-4165
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096K1
BCBS
—
01
—
3692
GHP
—
05
—
508602802
—
MD
Enumeration date
12/06/2006
Last updated
10/26/2011
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