MEDICARE: NEURO BRAIN CENTER OF AMERICA, LLC

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1518331172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO BRAIN CENTER OF AMERICA, LLC

Provider Business Mailing Address
First Line	:	521 W SOUTHLAKE BLVD
Second Line	:	SUITE 100
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6173
Country	:	US
Telephone Number	:	817-488-3238
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W SOUTHLAKE BLVD
Second Line	:	SUITE 100
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6173
Country	:	US
Telephone Number	:	817-488-3238
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BART STEELE
Credential	:
Telephone Number	:	817-488-3238

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	02/03/2016

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