Neurotech, LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

NEUROTECH, LLC

Practice address

520 Grand Central Ave Unit 204-B
Vienna, WV 26105-2187

Phone

(262) 875-6636

Fax

(262) 754-0897

NPI assigned

Jan 23, 2019

Organization subpart

No

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

Addresses

Other names 1

• Neurotech West Virginia Other name

Locations

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1811451925",
    "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": "520 GRAND CENTRAL AVE UNIT 204-B",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261052187",
            "telephone_number": "262-875-6636",
            "fax_number": "262-754-0897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8080 Beckett Center Dr Ste 213",
            "address_purpose": "LOCATION",
            "city": "West Chester",
            "state": "OH",
            "postal_code": "450695037",
            "country_code": "US",
            "telephone_number": "262-875-6616",
            "fax_number": "262-754-0897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEUROTECH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-05-23",
        "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 West Virginia",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Neurotech West Virginia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physiological Laboratory in Vienna, WV
• Providers in Vienna, WV by specialty
• Physiological Laboratory in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.