Provider Demographics
NPI:1295859296
Name:NEUROMONITORING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NEUROMONITORING ASSOCIATES, LLC
Other - Org Name:OVERWATCH NEURO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-808-9538
Mailing Address - Street 1:DEPT 880257 PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:303-756-9764
Mailing Address - Fax:
Practice Address - Street 1:4164 AUSTIN BLUFFS PKWY # 603
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2928
Practice Address - Country:US
Practice Address - Phone:303-756-9764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty