Southlake Neuromonitoring LLC
Electrodiagnostic Medicine in Ft Worth, TX. Organization (NPI-2).
NPI number1982172987
StatusActive
Last updated in NPPESNov 7, 2018
Details
- NPI
- 1982172987
- Entity type
- Organization (NPI-2)
- Legal business name
- Southlake Neuromonitoring LLC
- Organization subpart
- No
- Enumeration date
- Nov 7, 2018
- Last updated
- Nov 7, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204R00000X | Electrodiagnostic Medicine | – | – | Yes |
Practice location
111 Boland St Ste 211Ft Worth, TX 76107-1265
Phone 214-269-3875 · Fax 903-328-6568
Mailing address
111 Boland St Ste 211Ft Worth, TX 76107-1265
Authorized official
Gina Sullivan
Billing Manager
2142693875
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