Provider Demographics
NPI:1336787894
Name:NEPTUNE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:NEPTUNE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANGART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-595-7228
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-230-2912
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DR # D-1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-230-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty