MEDICARE: ACTIVE NEUROMONITORING 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	284300000X	Special Hospital

General Provider Information

NPI Number	:	1922412360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE NEUROMONITORING LLC

Provider Business Mailing Address
First Line	:	1451 W CYPRESS CREEK RD
Second Line	:	SUITE 300
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1961
Country	:	US
Telephone Number	:	954-446-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 W CYPRESS CREEK RD
Second Line	:	SUITE 300
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1961
Country	:	US
Telephone Number	:	954-446-7446
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	EMMANUAL EMAKPO
Credential	:
Telephone Number	:	954-446-7446

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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