Healthcare Provider Details

I. General information

NPI: 1962740274
Provider Name (Legal Business Name): LEGACY NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W FRANCIS AVE PMB #299
SPOKANE WA
99205-6834
US

IV. Provider business mailing address

1818 W FRANCIS AVE PMB #299
SPOKANE WA
99205-6834
US

V. Phone/Fax

Practice location:
  • Phone: 907-202-8303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: BRENT ADCOX
Title or Position: OWNER
Credential: M.D.
Phone: 907-202-8303