Provider Demographics
NPI:1083865778
Name:MID-TOWN NEUROMONITORING
Entity Type:Organization
Organization Name:MID-TOWN NEUROMONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-308-4567
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:MILAM
Mailing Address - State:TX
Mailing Address - Zip Code:75959-0116
Mailing Address - Country:US
Mailing Address - Phone:720-308-4567
Mailing Address - Fax:303-459-5180
Practice Address - Street 1:607 10TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5817
Practice Address - Country:US
Practice Address - Phone:720-308-4567
Practice Address - Fax:303-459-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty