Provider Demographics
NPI:1265620496
Name:SANDIA NEUROMONITORING LLC
Entity type:Organization
Organization Name:SANDIA NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-379-1997
Mailing Address - Street 1:600 CENTRAL AVE SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3656
Mailing Address - Country:US
Mailing Address - Phone:505-242-6432
Mailing Address - Fax:505-242-6431
Practice Address - Street 1:600 CENTRAL AVE SE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3656
Practice Address - Country:US
Practice Address - Phone:505-242-6432
Practice Address - Fax:505-242-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2010-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTSH01Medicare PIN
NMNMB2113Medicare PIN