Provider Demographics
NPI:1265803829
Name:HOMETOWN NEURODIAGNOSTICS-COLORADO LLC
Entity type:Organization
Organization Name:HOMETOWN NEURODIAGNOSTICS-COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-286-1016
Mailing Address - Street 1:200 UNION BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1830
Mailing Address - Country:US
Mailing Address - Phone:405-286-1016
Mailing Address - Fax:405-242-2016
Practice Address - Street 1:200 UNION BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1830
Practice Address - Country:US
Practice Address - Phone:405-286-1016
Practice Address - Fax:405-242-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty