Provider Demographics
NPI:1447618509
Name:NEUROMEDICAL LLC
Entity Type:Organization
Organization Name:NEUROMEDICAL LLC
Other - Org Name:NEUROASIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-338-2557
Mailing Address - Street 1:4578 N 1ST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5748
Mailing Address - Country:US
Mailing Address - Phone:520-338-2557
Mailing Address - Fax:520-844-9535
Practice Address - Street 1:4578 N 1ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5748
Practice Address - Country:US
Practice Address - Phone:520-338-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health