Provider Demographics
NPI:1922409903
Name:ADVANCED NEURO MONITORING LLC
Entity Type:Organization
Organization Name:ADVANCED NEURO MONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRASE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-0905
Mailing Address - Street 1:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:214-675-0905
Mailing Address - Fax:214-317-4888
Practice Address - Street 1:9521 RIVERSIDE PKWY STE B
Practice Address - Street 2:SUTE 338
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7422
Practice Address - Country:US
Practice Address - Phone:214-675-0905
Practice Address - Fax:214-317-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty