| Organization Name: | INTRAOPERATIVE NEUROLOGICAL MONITORING DIAGNOSTICS, LLC |
| NPI Number: | 1043613987 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN CASTLE (PRESIDENT) |
| Mailing Address: | 1990 Mcculloch Blvd N # D281 Lake Havasu City |
| State: | AZ US |
| Postal Code: | 864035749 |
| Phone Number: | 2813245660 |
| Fax Number: | 2813245679 |
| NPI Enumeration Date: | 10/07/2014 |
| NPI Last Update Date: | 10/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZE0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Electroneurodiagnostic |
| Taxonomy Definition: | |