Healthcare Provider Details

I. General information

NPI: 1235541509
Provider Name (Legal Business Name): REVOLUTION MONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 SOUTHPOINT DR
DALLAS TX
75248-2109
US

IV. Provider business mailing address

6437 SOUTHPOINT DR
DALLAS TX
75248-2109
US

V. Phone/Fax

Practice location:
  • Phone: 214-295-6703
  • Fax: 214-245-5267
Mailing address:
  • Phone: 214-295-6703
  • Fax: 214-245-5267

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. JEREMIAH TITUS VANCE
Title or Position: PRESIDENT/CEO
Credential: C.I.N.M.
Phone: 214-295-6703