MEDICARE: NEUROMONITORING ASSOCIATES, 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
1	174400000X	Specialist
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1295859296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROMONITORING ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	DEPT 880257 PO BOX 29650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:	303-756-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	4164 AUSTIN BLUFFS PKWY # 603
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2928
Country	:	US
Telephone Number	:	303-756-9764
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NICK LUEKENGA
Credential	:
Telephone Number	:	801-808-9538

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	09/27/2023

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