Provider Demographics
NPI:1821552951
Name:SURGICAL NEUROMONITORING SERVICES, LLC
Entity Type:Organization
Organization Name:SURGICAL NEUROMONITORING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-287-3093
Mailing Address - Street 1:DEPT 1137
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:720-287-3093
Mailing Address - Fax:
Practice Address - Street 1:1803 APPLE TREE LN
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-5202
Practice Address - Country:US
Practice Address - Phone:720-287-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty