MEDICARE: NEUROLOGICAL SURGERY SPECIALIST OF NORTH TEXAS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003389636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGICAL SURGERY SPECIALIST OF NORTH TEXAS PLLC

Provider Business Mailing Address
First Line	:	3808 KEMP BLVD STE A
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2150
Country	:	US
Telephone Number	:	940-234-3000
Fax Number	:	940-234-3005

Provider Business Practice Location Address
First Line	:	3808 KEMP BLVD STE A
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2150
Country	:	US
Telephone Number	:	940-234-3000
Fax Number	:	940-234-3005

Authorized Official
Title or Position	:	OWNER -SOLE MEMBER
Name	:	RICHARD KERN JR.
Credential	:	MD
Telephone Number	:	940-723-4572

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	08/30/2019

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