Healthcare Provider Details

I. General information

NPI: 1871000588
Provider Name (Legal Business Name): PEAK NEURO MONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 AUSTIN BLUFFS PKWY UNIT 603
COLORADO SPRINGS CO
80918-2928
US

IV. Provider business mailing address

DEPT 880257 PO BOX 29650
PHOENIX AZ
85038-9650
US

V. Phone/Fax

Practice location:
  • Phone: 303-704-4621
  • Fax:
Mailing address:
  • Phone: 303-704-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DOREEN SHINN
Title or Position: VP
Credential:
Phone: 303-704-4621