MEDICARE: NEUROTECH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246ZE0500X	EEG Specialist/Technologist
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
3	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
4	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1083375844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTECH, LLC

Provider Business Mailing Address
First Line	:	626 W MORELAND BLVD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-2433
Country	:	US
Telephone Number	:	262-754-0898
Fax Number	:	262-754-0897

Provider Business Practice Location Address
First Line	:	1022 W INA RD STE 107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-3109
Country	:	US
Telephone Number	:	262-875-6617
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CONTRACTING & RESEARCH
Name	:	KRISTINE LISA WILDNER
Credential	:
Telephone Number	:	262-875-6572

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	01/04/2022

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