Healthcare Provider Details

I. General information

NPI: 1750921508
Provider Name (Legal Business Name): RED ROCK INTEROPERATIVE NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 03/02/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 E CAMELBACK RD STE 2589
PHOENIX AZ
85016-4502
US

IV. Provider business mailing address

3104 E CAMELBACK RD STE 2589
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 866-374-6628
  • Fax: 866-951-1120
Mailing address:
  • Phone: 866-374-6628
  • Fax: 866-951-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY MCCLINTOCK
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 866-374-6628