Provider Demographics
NPI:1942173414
Name:SOMA ELECTRO-NEURODIAGNOSTICS LLC
Entity type:Organization
Organization Name:SOMA ELECTRO-NEURODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISK
Authorized Official - Suffix:
Authorized Official - Credentials:REEG T
Authorized Official - Phone:701-361-6872
Mailing Address - Street 1:2700 12TH AVE S STE D
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:701-361-6872
Mailing Address - Fax:701-786-7319
Practice Address - Street 1:2700 12TH AVE S STE D
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8723
Practice Address - Country:US
Practice Address - Phone:701-499-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty