Organization
NEUROTECH, LLC
Active
Other names
Neurotech West Virginia
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
520 GRAND CENTRAL AVE UNIT 204-B, VIENNA, WV 26105-2187
(262) 875-6636
(262) 754-0897
Mailing address
626 W MORELAND BLVD, WAUKESHA, WI 53188-2433
(262) 875-6572
(262) 754-0897
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
Enumeration date
01/23/2019
Last updated
05/23/2019
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