Provider Demographics
NPI:1730307307
Name:PHYSIOM NEUROMONITORING CONSULTANTS
Entity type:Organization
Organization Name:PHYSIOM NEUROMONITORING CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:303-426-3927
Mailing Address - Street 1:10940 S PARKER RD
Mailing Address - Street 2:#130
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7440
Mailing Address - Country:US
Mailing Address - Phone:303-426-3927
Mailing Address - Fax:
Practice Address - Street 1:10940 S PARKER RD
Practice Address - Street 2:#130
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7440
Practice Address - Country:US
Practice Address - Phone:303-426-3927
Practice Address - Fax:720-876-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO470246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty