MEDICARE: AMBULATORY NEUROLOGICAL SERVICES, 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	246ZE0500X	EEG Specialist/Technologist

General Provider Information

NPI Number	:	1700159480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY NEUROLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 28669
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92198-0669
Country	:	US
Telephone Number	:	888-447-5904
Fax Number	:	866-273-5772

Provider Business Practice Location Address
First Line	:	10554 SUCCESS LN
Second Line	:	STE C
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-3658
Country	:	US
Telephone Number	:	937-350-5341
Fax Number	:	866-273-5772

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MIGUEL IRIBARREN
Credential	:
Telephone Number	:	847-340-9726

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/16/2017

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