MEDICARE: NEUROVAS TREATMENT CENTERS

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	208D00000X	General Practice Physician	E1245	TX

General Provider Information

NPI Number	:	1598700106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROVAS TREATMENT CENTERS

Provider Business Mailing Address
First Line	:	5000 QUAIL CREEK DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-5310
Country	:	US
Telephone Number	:	972-529-1008
Fax Number	:	972-540-1344

Provider Business Practice Location Address
First Line	:	603 MATLOCK CENTRE CIR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2535
Country	:	US
Telephone Number	:	817-795-5470
Fax Number	:	817-795-5472

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MELTON
Credential	:
Telephone Number	:	972-529-1008

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/22/2020

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