Provider Demographics
NPI:1043613987
Name:INTRAOPERATIVE NEUROLOGICAL MONITORING DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:INTRAOPERATIVE NEUROLOGICAL MONITORING DIAGNOSTICS, LLC
Other - Org Name:ION.MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-324-5660
Mailing Address - Street 1:1990 MCCULLOCH BLVD N # D281
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5749
Mailing Address - Country:US
Mailing Address - Phone:281-324-5660
Mailing Address - Fax:281-324-5679
Practice Address - Street 1:1990 MCCULLOCH BLVD N # D281
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5749
Practice Address - Country:US
Practice Address - Phone:281-324-5660
Practice Address - Fax:281-324-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty