Basic Information
| Provider Information | |||||||||
| NPI: | 1487131041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSURE NEUROMONITORING PENNSYLVANIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 1137 | ||||||||
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| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741820001 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | DEPT 1137 | ||||||||
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| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741820001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | PRESTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 7202873093 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASSURE NEUROMONITORING LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.