MEDICARE: NEURO DIAGNOSTICS, 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
1	2085R0202X	Diagnostic Radiology Physician		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5875079468	OTHER	MS	BCBS

General Provider Information

NPI Number	:	1982603262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	240 EISENHOWER DR
Second Line	:	STE C-5
City	:	BILOXI
State	:	MS
Zip	:	39531-3654
Country	:	US
Telephone Number	:	228-385-1725
Fax Number	:	228-385-7366

Provider Business Practice Location Address
First Line	:	240 EISENHOWER DR
Second Line	:	STE C-5
City	:	BILOXI
State	:	MS
Zip	:	39531-3654
Country	:	US
Telephone Number	:	228-385-1725
Fax Number	:	228-385-7366

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN M FELSHER
Credential	:	CEO
Telephone Number	:	228-385-1725

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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