Organization
NEUROTECH, LLC
Active
Other names
Neurotech Washington Spokane
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE LISA WILDNER (DIRECTOR OF CONTRACTING & RESEARCH)
(262) 875-6572
Entity
Organization
Contact information
Practice address
2510 N PINES RD, SUITE 5, SPOKANE VALLEY, WA 99206-7636
(509) 624-4313
Mailing address
626 W MORELAND BLVD, WAUKESHA, WI 53188-2433
(262) 754-0898
Taxonomy
Speciality
Code
Description
License number
State
2472E0500X
EEG Technician
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
293D00000X
Physiological Laboratory
Primary
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225056252
—
WA
01
—
G8927644
MEDICARE PTAN
WA
Enumeration date
08/01/2014
Last updated
03/09/2019
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