Healthcare Provider Details

I. General information

NPI: 1407597529
Provider Name (Legal Business Name): B2LS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COWBOYS WAY STE 300
FRISCO TX
75034-2074
US

IV. Provider business mailing address

5 COWBOYS WAY STE 300
FRISCO TX
75034-2074
US

V. Phone/Fax

Practice location:
  • Phone: 214-629-3576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOBBY SMITH II
Title or Position: OWNER
Credential:
Phone: 214-629-3576