Healthcare Provider Details

I. General information

NPI: 1679951479
Provider Name (Legal Business Name): BENCHMARK DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CANTON ST
DALLAS TX
75226-1605
US

IV. Provider business mailing address

3020 CANTON ST
DALLAS TX
75226-1605
US

V. Phone/Fax

Practice location:
  • Phone: 214-212-5737
  • Fax: 214-427-8860
Mailing address:
  • Phone: 214-212-5737
  • Fax: 214-427-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN SULLIVAN
Title or Position: MANAGER
Credential:
Phone: 214-212-5737