Healthcare Provider Details

I. General information

NPI: 1871891457
Provider Name (Legal Business Name): KCM NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S PEARL ST
DENVER CO
80210-4040
US

IV. Provider business mailing address

PO BOX 100551
DENVER CO
80250-0551
US

V. Phone/Fax

Practice location:
  • Phone: 281-462-7684
  • 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: TERRELL MCCASLAND
Title or Position: MEMBER MANAGER
Credential: CNIM
Phone: 281-462-7684