Healthcare Provider Details

I. General information

NPI: 1083913792
Provider Name (Legal Business Name): NEUROSTIMULATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

PO BOX 413076
SALT LAKE CITY UT
84141-3076
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1575
  • Fax:
Mailing address:
  • Phone: 801-587-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD WEEKS
Title or Position: DEPTARTMENT CHAIR
Credential:
Phone: 801-583-2500