MEDICARE: DORMAN LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	2472E0500X	EEG Technician
3	261QR0200X	Radiology Clinic/Center
4	246ZE0500X	EEG Specialist/Technologist
5	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1285248666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORMAN LLC

Provider Business Mailing Address
First Line	:	PO BOX 6529
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5114
Country	:	US
Telephone Number	:	844-212-5321
Fax Number	:	214-594-9559

Provider Business Practice Location Address
First Line	:	3500 CENTRAL AVE STE A
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68847-2963
Country	:	US
Telephone Number	:	844-212-5321
Fax Number	:	214-594-9559

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FRANK GRAY III
Credential	:
Telephone Number	:	844-212-5321

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	01/28/2021

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Directions to “DORMAN LLC ” Practice Location

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