Healthcare Provider Details

I. General information

NPI: 1114419926
Provider Name (Legal Business Name): ROOT NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 WARREN DR
DENVER CO
80221-2662
US

IV. Provider business mailing address

PO BOX 21301
DENVER CO
80221-0301
US

V. Phone/Fax

Practice location:
  • Phone: 419-674-7116
  • Fax:
Mailing address:
  • Phone:
  • 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: TYLER ROOT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 419-674-7116