Basic Information
| Provider Information | |||||||||
| NPI: | 1821552951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL NEUROMONITORING SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 1137 | ||||||||
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| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741820001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1803 APPLE TREE LN | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180155202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2019 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | WAGENER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7202873093 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.