MEDICARE: TSIGE WASHUN R.EEG

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1396170122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSIGE WASHUN R.EEG

Provider Business Mailing Address
First Line	:	PO BOX 889
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80151-0889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE
Second Line	:	STE 570
City	:	DENVER
State	:	CO
Zip	:	80210-7009
Country	:	US
Telephone Number	:	303-715-9024
Fax Number	:	303-715-7057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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