Provider Demographics
NPI:1336467422
Name:INTRAOPERATIVE MONITORING ASSOC
Entity Type:Organization
Organization Name:INTRAOPERATIVE MONITORING ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-920-1171
Mailing Address - Street 1:8400 MENAUL BLVD. A211
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2260
Mailing Address - Country:US
Mailing Address - Phone:505-836-7894
Mailing Address - Fax:888-315-4512
Practice Address - Street 1:1817 W. 800 N
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84025
Practice Address - Country:US
Practice Address - Phone:505-836-7894
Practice Address - Fax:888-315-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty