Provider Demographics
NPI:1427380278
Name:WESTERN COLORADO TECHNICAL NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:WESTERN COLORADO TECHNICAL NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-588-4845
Mailing Address - Street 1:PO BOX 413136
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3136
Mailing Address - Country:US
Mailing Address - Phone:225-588-4845
Mailing Address - Fax:225-612-6561
Practice Address - Street 1:2580 ALLEN ADALE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2580
Practice Address - Country:US
Practice Address - Phone:225-588-4845
Practice Address - Fax:225-612-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
CNIM 881246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty