Healthcare Provider Details

I. General information

NPI: 1487192282
Provider Name (Legal Business Name): PALISADE NEURO ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SPUR DR
NEW CASTLE CO
81647-8518
US

IV. Provider business mailing address

107 SPUR DR
NEW CASTLE CO
81647-8518
US

V. Phone/Fax

Practice location:
  • Phone: 970-309-9158
  • Fax:
Mailing address:
  • Phone: 970-309-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN A HUEBSCH
Title or Position: MEMBER
Credential: CNIM
Phone: 970-309-9158