MEDICARE: IONM PHYSICIANS SERVICES, S.C.

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1679165740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IONM PHYSICIANS SERVICES, S.C.

Provider Business Mailing Address
First Line	:	4833 FRONT ST UNIT 406B
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7902
Country	:	US
Telephone Number	:	720-435-5129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 RIDGECREST
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-3160
Country	:	US
Telephone Number	:	815-715-2299
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDREW LOVELAND
Credential	:
Telephone Number	:	720-435-5129

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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