NPIMap

Organization Active NPI

Neurotech, LLC

  • Physiological Laboratory
  • Green Bay, WI
National Provider Identifier
1336780717
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
NEUROTECH, LLC
Practice address
1263 Main St Ste 120
Green Bay, WI 54302-1341
Phone
(262) 875-6612
NPI assigned
Oct 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristine Lisa Wildner
Title
Director of Contracting & Research
Phone
(262) 875-6572

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
EEG TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 2472E0500X
Sleep Disorder Diagnostic Clinic/Center 261QS1200X
Physiological Laboratory 293D00000X Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X

Addresses

Primary practice location

1263 Main St Ste 120
Green Bay, WI 54302-1341

Mailing address

3232 Ridge Rd
Suite 5
Lansing, IL 60438-3127
Phone (708) 889-6096

Other names 1

  • Neurotech, LLC Fixed IDTF Other name

National Provider Directory

National Provider Directory
Tax ID family
Neurotech LLC20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

3232 Ridge Rd
Ste 5
Lansing, IL 60438

1263 Main St
Ste 213
Green Bay, WI 54302
Phone (262) 875-6634

1263 Main St
Ste 120
Green Bay, WI 54302
Phone (262) 875-6612

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1336780717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 RIDGE RD",
            "address_2": "SUITE 5",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604383127",
            "telephone_number": "708-889-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 MAIN ST STE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543021341",
            "telephone_number": "262-875-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROTECH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "WILDNER",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING & RESEARCH",
        "authorized_official_telephone_number": "262-875-6572"
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurotech, LLC Fixed IDTF",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Neurotech, LLC Fixed IDTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.