Healthcare Provider Details

I. General information

NPI: 1689119075
Provider Name (Legal Business Name): ARTEMIS INTRAOPERATIVE MONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 DALLAS PKWY STE 300
ADDISON TX
75001-6470
US

IV. Provider business mailing address

15305 DALLAS PKWY STE 300
ADDISON TX
75001-6470
US

V. Phone/Fax

Practice location:
  • Phone: 214-810-3449
  • Fax: 972-476-0771
Mailing address:
  • Phone: 214-810-3449
  • Fax: 972-476-0771

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: DIANA KOUTINAS
Title or Position: CEO
Credential: CNIM R.EP T
Phone: 469-226-8398