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General NPI Number Information
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NPI Number | 1174855928
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Entity Type | Organization
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Legal Business Name | WESTERN COLORADO PROFESSIONAL NEUROMONITORING
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 2580 ALLEN ADALE RD
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City | FAIRBANKS
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State | AK
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Zip | 99709-2580
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Country | US
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Telephone | 225-588-4845
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Fax | 225-612-6561
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Provider Business Mailing Address
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Address Line | PO BOX 413136
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City | SALT LAKE CITY
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State | UT
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Zip | 84141-3136
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Country | US
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Telephone | 225-588-4845
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Fax | 225-612-6561
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Authorized Official
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Title or Position | CONTACT PERSON
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Name | KATHY REED
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Credential |
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Telephone | 225-588-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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