Healthcare Provider Details

I. General information

NPI: 1942795190
Provider Name (Legal Business Name): NEUROTECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 RAMADA WAY STE 204
GREEN BAY WI
54304-5700
US

IV. Provider business mailing address

626 W MORELAND BLVD
WAUKESHA WI
53188-2433
US

V. Phone/Fax

Practice location:
  • Phone: 866-374-7648
  • Fax:
Mailing address:
  • Phone: 262-875-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHRIS BLANK
Title or Position: CONTRACTING & CREDENTIALING MANAGER
Credential:
Phone: 262-875-6575