Healthcare Provider Details

I. General information

NPI: 1639576242
Provider Name (Legal Business Name): BEACON MONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

IV. Provider business mailing address

530 KNIGHTSBRIDGE RD
FAIRBANKS AK
99709-2468
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-8181
  • Fax:
Mailing address:
  • Phone: 559-905-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT JOSEPH TYLER
Title or Position: OWNER
Credential: MD
Phone: 559-905-2736