Provider Demographics
NPI:1083906325
Name:PRECISION NEURO MONITORING LLC
Entity Type:Organization
Organization Name:PRECISION NEURO MONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-926-7050
Mailing Address - Street 1:1955 W BASELINE RD
Mailing Address - Street 2:STE 113-431
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9003
Mailing Address - Country:US
Mailing Address - Phone:602-926-7050
Mailing Address - Fax:
Practice Address - Street 1:1955 W BASELINE RD
Practice Address - Street 2:STE 113-431
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9003
Practice Address - Country:US
Practice Address - Phone:602-926-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty