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NPI Code Detail

MEDICARE: NEUROWORKS LLC

MEDICARE: NEUROWORKS LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist3125CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184176067
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROWORKS LLC
Provider Business Mailing Address
First Line : 255 CANYON BLVD STE 200
Second Line :
City : BOULDER
State : CO
Zip : 80302-4954
Country : US
Telephone Number : 720-744-0577
Fax Number : 720-638-3699
Provider Business Practice Location Address
First Line : 255 CANYON BLVD STE 200
Second Line :
City : BOULDER
State : CO
Zip : 80302-4954
Country : US
Telephone Number : 303-945-5311
Fax Number :
Authorized Official
Title or Position : CLINICAL NEUROPSYCHOLOGIST/OWNER
Name : DR. TIMOTHY BRUNELLE
Credential :
Telephone Number : 720-744-0577
Provider Enumeration Date : 10/26/2016
Last Update Date : 02/04/2022

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