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NPI Code Detail

MEDICARE: NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC

MEDICARE: NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, 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
12084N0400XNeurology PhysicianL2694TX

General Provider Information

NPI Number : 1689985038
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC
Provider Business Mailing Address
First Line : 621 PALO DURO DR
Second Line :
City : HURST
State : TX
Zip : 76054-6009
Country : US
Telephone Number : 817-886-0369
Fax Number : 817-268-9011
Provider Business Practice Location Address
First Line : 4931 LONG PRAIRIE RD STE 100
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-2787
Country : US
Telephone Number : 817-886-0369
Fax Number : 817-268-9011
Authorized Official
Title or Position : PRESIDENT
Name : MADHAVI THOMAS
Credential : MD
Telephone Number : 817-886-0369
Provider Enumeration Date : 06/30/2010
Last Update Date : 06/07/2022

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Directions to “NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC ” Practice Location

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