Healthcare Provider Details

I. General information

NPI: 1700159480
Provider Name (Legal Business Name): AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10554 SUCCESS LN STE C
CENTERVILLE OH
45458-3658
US

IV. Provider business mailing address

PO BOX 28669
SAN DIEGO CA
92198-0669
US

V. Phone/Fax

Practice location:
  • Phone: 937-350-5341
  • Fax: 866-273-5772
Mailing address:
  • Phone: 888-447-5904
  • Fax: 866-273-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIGUEL IRIBARREN
Title or Position: MANAGER
Credential:
Phone: 847-340-9726