Provider Demographics
NPI:1780046706
Name:AMERICA GARDEN NEUROSCIENCES LLC
Entity Type:Organization
Organization Name:AMERICA GARDEN NEUROSCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-315-4018
Mailing Address - Street 1:4450 UNION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-2865
Mailing Address - Country:US
Mailing Address - Phone:970-315-4018
Mailing Address - Fax:
Practice Address - Street 1:4450 UNION ST STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-2865
Practice Address - Country:US
Practice Address - Phone:970-315-4018
Practice Address - Fax:970-315-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty