Healthcare Provider Details

I. General information

NPI: 1811435886
Provider Name (Legal Business Name): NEUROTECH NORTHWEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 140TH PL NE STE 105
BELLEVUE WA
98007-3943
US

IV. Provider business mailing address

626 W MORELAND BLVD
WAUKESHA WI
53188-2433
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-0375
  • Fax:
Mailing address:
  • Phone: 262-754-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LANCE MORGAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 262-754-0898