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General NPI Number Information
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NPI Number | 1659640381
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN NEURODIAGNOSTICS, LLC
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1908 THOMES AVE STE 12550
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City | CHEYENNE
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State | WY
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Zip | 82001-3527
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Country | US
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Telephone | 303-776-5298
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Fax | 303-682-2785
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Provider Business Mailing Address
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Address Line | 1908 THOMES AVE STE 12550
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City | CHEYENNE
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State | WY
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Zip | 82001-3527
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Country | US
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Telephone | 303-776-5298
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Fax | 303-682-2785
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Authorized Official
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Title or Position | PAYER CREDENTIALING SPECIALIST
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Name | KIA CHURCHWELL
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Credential |
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Telephone | 615-933-0792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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