| Northwest Neurology Pc | |
|
90 Health Park Dr Louisville CO 80027-9757 | |
| (303) 426-0215 | |
| (303) 426-4003 |
| Full Name | Northwest Neurology Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 90 Health Park Dr, Louisville, Colorado |
| Authorized Official Name and Position | Sandi Hynes (BILLING MGR) |
| Authorized Official Contact | 3034260215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Neurology Pc 90 Health Park Dr. 390 Louisville CO 80027-9742 Ph: (303) 426-0215 | Northwest Neurology Pc 90 Health Park Dr Louisville CO 80027-9757 Ph: (303) 426-0215 |
| NPI Number | 1629154828 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0941190193 |
|---|---|
| Medicare Enrollment ID | O20040319000431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629154828 | NPI | - | NPPES |
| 04008991 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | William J Wagner |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598738155 PECOS PAC ID: 5496716896 Enrollment ID: I20100827000766 |
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