Provider Demographics
NPI:1063401461
Name:SURGICAL NEUROMONITORING SERVICE INC
Entity type:Organization
Organization Name:SURGICAL NEUROMONITORING SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOCHAEV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-573-2341
Mailing Address - Street 1:3005 SANTA MARGARITA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8205
Mailing Address - Country:US
Mailing Address - Phone:707-573-2341
Mailing Address - Fax:707-539-2939
Practice Address - Street 1:3005 SANTA MARGARITA CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8205
Practice Address - Country:US
Practice Address - Phone:707-573-2341
Practice Address - Fax:707-539-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12851103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P58177Medicare UPIN
CAOPL128510Medicare ID - Type Unspecified