Provider Demographics
NPI:1053602987
Name:COCHISE COUNTY NEURODIAGNOSTICS
Entity type:Organization
Organization Name:COCHISE COUNTY NEURODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDALEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RPSGT, REEGT
Authorized Official - Phone:520-335-7135
Mailing Address - Street 1:2160 E FRY BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2794
Mailing Address - Country:US
Mailing Address - Phone:520-335-7135
Mailing Address - Fax:
Practice Address - Street 1:2160 E FRY BLVD STE C5
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2794
Practice Address - Country:US
Practice Address - Phone:520-335-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8867261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic