| Organization Name: | DIVA INTRA-OPERATIVE MONITORING LLC |
| NPI Number: | 1437523065 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN J IPSEN (MEMBER) |
| Mailing Address: | 444 Four States Dr Galena |
| State: | KS US |
| Postal Code: | 667394324 |
| Phone Number: | 6207834441 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2015 |
| NPI Last Update Date: | 11/19/2015 |
| 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: | |