Healthcare Provider Details

I. General information

NPI: 1942526835
Provider Name (Legal Business Name): SOUTH DENVER NEUROMONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 JASMINE ST
DENVER CO
80220-5913
US

IV. Provider business mailing address

PO BOX 1288
CROSBY TX
77532-1288
US

V. Phone/Fax

Practice location:
  • Phone: 281-462-1285
  • Fax:
Mailing address:
  • Phone: 281-462-1285
  • Fax: 281-462-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BEN GUIOT
Title or Position: OWNER
Credential: MD
Phone: 281-462-1285