Provider Demographics
NPI:1396256293
Name:CRANIOM LLC
Entity type:Organization
Organization Name:CRANIOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, REPT, CNIM
Authorized Official - Phone:701-388-5390
Mailing Address - Street 1:575 LOS ALTOS CIR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-2523
Mailing Address - Country:US
Mailing Address - Phone:701-388-5390
Mailing Address - Fax:
Practice Address - Street 1:575 LOS ALTOS CIR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-2523
Practice Address - Country:US
Practice Address - Phone:701-388-5390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3282246ZE0600X
2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty