Provider Demographics
NPI:1518597855
Name:INTACT NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:INTACT NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:724-689-9591
Mailing Address - Street 1:PO BOX 40856
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3295 BLAKE ST APT 304
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2469
Practice Address - Country:US
Practice Address - Phone:724-689-9591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012OtherCERTIFIED NEURO - INTRAOPERATIVE MONITORING
1816OtherCERTIFIED NEURO - INTRAOPERATIVE MONITORING