Basic Information
| Provider Information | |||||||||
| NPI: | 1063858322 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEURO SURGERY ONE- EMERGENCY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 S. BROADWAY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206387500 | ||||||||
| FaxNumber: | 3035862292 | ||||||||
| Practice Location | |||||||||
| Address1: | 7780 S. BROADWAY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206387500 | ||||||||
| FaxNumber: | 3035862292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | PRALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7206387500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.