Provider Demographics
NPI:1871703397
Name:INTRAOPERATIVE MONITORING SERVICES
Entity type:Organization
Organization Name:INTRAOPERATIVE MONITORING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNLEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-967-9300
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE #30833
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:916-967-9300
Mailing Address - Fax:916-967-9301
Practice Address - Street 1:5510 BIRDCAGE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7620
Practice Address - Country:US
Practice Address - Phone:916-967-9300
Practice Address - Fax:916-967-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61359208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G613590Medicare ID - Type Unspecified