MEDICARE: MOBILE EEG TESTING INC

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1376218396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE EEG TESTING INC

Provider Business Mailing Address
First Line	:	4101 W GREEN OAKS BLVD STE 305
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-6800
Country	:	US
Telephone Number	:	800-323-1771
Fax Number	:	817-483-4068

Provider Business Practice Location Address
First Line	:	1420 N COOPER ST STE 110
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-8530
Country	:	US
Telephone Number	:	800-323-1771
Fax Number	:	817-483-4068

Authorized Official
Title or Position	:	OWNER
Name	:	MAHNAZ J DARVISHY
Credential	:
Telephone Number	:	817-405-7582

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	12/16/2021

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