Healthcare Provider Details

I. General information

NPI: 1639452634
Provider Name (Legal Business Name): AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 TEAYS VALLEY RD STE E
HURRICANE WV
25526-9622
US

IV. Provider business mailing address

PO BOX 28669
SAN DIEGO CA
92198-0669
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-9177
  • 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 Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

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