Provider Demographics
NPI:1487054151
Name:NEUROTECH, LLC
Entity type:Organization
Organization Name:NEUROTECH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-754-0898
Mailing Address - Street 1:626 W MORELAND BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2433
Mailing Address - Country:US
Mailing Address - Phone:262-754-0898
Mailing Address - Fax:262-754-0897
Practice Address - Street 1:2435 KIMBERLY RD
Practice Address - Street 2:SUITE 45 NORTH
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-888-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROTECH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-29
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1225056252Medicaid
IAIB3297Medicare UPIN