Provider Demographics
NPI:1487192282
Name:PALISADE NEURO ASSOCIATES
Entity Type:Organization
Organization Name:PALISADE NEURO ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUEBSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:970-309-9158
Mailing Address - Street 1:107 SPUR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-8518
Mailing Address - Country:US
Mailing Address - Phone:970-309-9158
Mailing Address - Fax:
Practice Address - Street 1:107 SPUR DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-8518
Practice Address - Country:US
Practice Address - Phone:970-309-9158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty