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General NPI Number Information
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NPI Number | 1629457387
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Entity Type | Organization
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Legal Business Name | HALSTEAD MONITORING LLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 2226 SHADOWLAKE DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7440
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Country | US
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Telephone | 405-622-3827
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890161
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City | OKLAHOMA CITY
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State | OK
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Zip | 73189-0161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JUSTIN BOMAN
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Credential |
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Telephone | 405-622-3827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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