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NPI Code Detail

MEDICARE: NEUROTECH, LLC

MEDICARE: NEUROTECH, 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
1246ZE0500XEEG Specialist/Technologist
2261QS1200XSleep Disorder Diagnostic Clinic/Center
3335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
4293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1942795190
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROTECH, LLC
Provider Business Mailing Address
First Line : 626 W MORELAND BLVD
Second Line :
City : WAUKESHA
State : WI
Zip : 53188-2433
Country : US
Telephone Number : 262-875-6572
Fax Number :
Provider Business Practice Location Address
First Line : 2830 RAMADA WAY STE 204
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-5700
Country : US
Telephone Number : 866-374-7648
Fax Number :
Authorized Official
Title or Position : CONTRACTING & CREDENTIALING MANAGER
Name : CHRIS BLANK
Credential :
Telephone Number : 262-875-6575
Provider Enumeration Date : 06/28/2018
Last Update Date : 09/03/2024

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Directions to “NEUROTECH, LLC ” Practice Location

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