Healthcare Provider Details

I. General information

NPI: 1861976169
Provider Name (Legal Business Name): NOBLE NEURODIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CALCASIEU XING
LAFAYETTE LA
70506-7873
US

IV. Provider business mailing address

205 CALCASIEU XING
LAFAYETTE LA
70506-7873
US

V. Phone/Fax

Practice location:
  • Phone: 337-366-7535
  • Fax: 713-893-6967
Mailing address:
  • Phone: 337-366-7535
  • Fax: 713-893-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK FRANGULLIE
Title or Position: CHIEF OPERATING OFFICER
Credential: CNIM
Phone: 713-865-0730