Healthcare Provider Details

I. General information

NPI: 1982907143
Provider Name (Legal Business Name): NEURO DIAGNOSTIC HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S FREEWAY SUITE 204
FORT WORTH TX
76104-5064
US

IV. Provider business mailing address

5904 S COOPER ST SUITE 104-184
ARLINGTON TX
76017-4494
US

V. Phone/Fax

Practice location:
  • Phone: 469-831-7111
  • Fax:
Mailing address:
  • Phone: 469-831-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DARRYL EVANS
Title or Position: COO
Credential: J.D.
Phone: 469-831-7111