Provider Demographics
NPI:1538393004
Name:ADVANCED NEURODIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ADVANCED NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:R EEG T, CNIM, CLTM
Authorized Official - Phone:702-373-8101
Mailing Address - Street 1:8550 W CHARLESTON BLVD
Mailing Address - Street 2:102-171
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9210
Mailing Address - Country:US
Mailing Address - Phone:702-258-3315
Mailing Address - Fax:702-583-7920
Practice Address - Street 1:601 S RANCHO DR
Practice Address - Street 2:SUITE A-4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4899
Practice Address - Country:US
Practice Address - Phone:702-258-3315
Practice Address - Fax:702-583-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538393004Medicaid
NV1538393004Medicaid