Healthcare Provider Details

I. General information

NPI: 1124667746
Provider Name (Legal Business Name): APPLIED INTRAOPERATIVE CARE TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGHLAND PARK VLG # 100-469
DALLAS TX
75205-2789
US

IV. Provider business mailing address

25 HIGHLAND PARK VLG # 100-469
DALLAS TX
75205-2789
US

V. Phone/Fax

Practice location:
  • Phone: 214-536-1647
  • Fax: 214-580-7600
Mailing address:
  • Phone: 214-536-1647
  • Fax: 214-580-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE SHOUP COLLINS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 214-536-1647