MEDICARE: J&M DIAGNOSTICS, 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1790926715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&M DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	17080 DALLAS PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1921
Country	:	US
Telephone Number	:	214-701-5447
Fax Number	:	214-279-0528

Provider Business Practice Location Address
First Line	:	4201 W PARMER LN
Second Line	:	BLDG C, SUITE 150
City	:	AUSTIN
State	:	TX
Zip	:	78727-4109
Country	:	US
Telephone Number	:	214-701-5447
Fax Number	:	214-279-0528

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARY M TITUS
Credential	:	MBA
Telephone Number	:	214-701-5447

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	05/18/2009

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