Basic Information
| Provider Information | |||||||||
| NPI: | 1861836686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 S TEJON ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662268576 | ||||||||
| FaxNumber: | 8666178910 | ||||||||
| Practice Location | |||||||||
| Address1: | 13 S TEJON ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662268576 | ||||||||
| FaxNumber: | 8666178910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.