MEDICARE: NEURODYME DIAGNOSTICS

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	:	1629152640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURODYME DIAGNOSTICS

Provider Business Mailing Address
First Line	:	3422 GARDEN SHADOW LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6346
Country	:	US
Telephone Number	:	832-876-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3422 GARDEN SHADOW LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6346
Country	:	US
Telephone Number	:	832-876-7084
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY HAYDEN ROSE
Credential	:	MA
Telephone Number	:	832-876-7084

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/14/2008

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