Neurotech, LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

NEUROTECH, LLC

Practice address

1820 Ridge Rd Ste 303a
Homewood, IL 60430-1759

Phone

(708) 960-3997

Fax

(262) 754-0897

NPI assigned

Sep 26, 2018

Organization subpart

Yes

Parent organization

NEUROTECH, LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Kristine Lisa Wildner

Title

Director of Contracting & Research

Phone

(262) 875-6572

Specialties & licenses 4

Addresses

Other names 1

• Neurotech, LLC Homewood IL Former legal business name

Part of

Neurotech LLC

Locations

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

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552089600000",
    "number": "1447735451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882433",
            "telephone_number": "262-875-6572",
            "fax_number": "262-754-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 RIDGE RD STE 303A",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604301759",
            "telephone_number": "708-960-3997",
            "fax_number": "262-754-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROTECH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEUROTECH, LLC",
        "enumeration_date": "2018-09-26",
        "last_updated": "2019-03-09",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "246ZE0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, 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 Homewood IL",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Neurotech, LLC Homewood IL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Physiological Laboratory in Homewood, IL
• Providers in Homewood, IL by specialty
• Physiological Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2019; 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.