Provider Demographics
NPI:1306892922
Name:AMBULATORY EEG RECORDINGS LLC
Entity type:Organization
Organization Name:AMBULATORY EEG RECORDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-241-1701
Mailing Address - Street 1:PO BOX 170602
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-8051
Mailing Address - Country:US
Mailing Address - Phone:262-241-1701
Mailing Address - Fax:262-241-1801
Practice Address - Street 1:10325 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5764
Practice Address - Country:US
Practice Address - Phone:262-241-1701
Practice Address - Fax:262-241-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI647186261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI92235Medicare ID - Type Unspecified