Healthcare Provider Details

I. General information

NPI: 1992283485
Provider Name (Legal Business Name): NEURODIAGNOSTICS TEX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 JEFFERSON AVENUE SUITE 32
TEXARKANA AR
71854-1143
US

IV. Provider business mailing address

4803 JEFFERSON AVENUE SUITE 32
TEXARKANA AR
71854-1143
US

V. Phone/Fax

Practice location:
  • Phone: 972-724-5446
  • Fax: 972-724-5447
Mailing address:
  • Phone: 972-724-5446
  • Fax: 972-724-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOEY MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-534-8812