Community Neurologic Center SC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

036-093008 Issued in IL

Legal business name

COMMUNITY NEUROLOGIC CENTER SC

Practice address

2172 Blackberry Dr
Suite 202
Geneva, IL 60134-1073

Phone

(630) 208-7735

Fax

(630) 208-6956

NPI assigned

Jul 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Boris Lake

Title

Business Manager

Phone

(630) 208-7735

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1487852679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2172 BLACKBERRY DR",
            "address_2": "SUITE 202",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601341073",
            "telephone_number": "630-208-7735",
            "fax_number": "630-208-6956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 BLACKBERRY DR",
            "address_2": "SUITE 202",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601341073",
            "telephone_number": "630-208-7735",
            "fax_number": "630-208-6956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY NEUROLOGIC CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "630-208-7735",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036-093008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "036-093008",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093008",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clear Mountain Therapy LLC
• Clear Path Counseling, PLLC
• Steven Coker, M.D.
• Carson Collins, RBT
• Nicole Collins
• Community Neurologic Center SC
• Conley and Associates LLC
• Tamara Connelly
• Kristin Conniff, PT, DPT, OCS
• Paula Conrin, M.D.

• Clinic/Center in Geneva, IL
• Providers in Geneva, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.