Healthcare Provider Details

I. General information

NPI: 1386049989
Provider Name (Legal Business Name): IONM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W ROYAL LN SUITE 196
IRVING TX
75063-1996
US

IV. Provider business mailing address

PO BOX 205778
DALLAS TX
75320-5778
US

V. Phone/Fax

Practice location:
  • Phone: 281-346-3480
  • Fax: 832-581-4677
Mailing address:
  • Phone: 281-346-3480
  • Fax: 832-581-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF KROPHOLLER
Title or Position: DIRECTOR
Credential:
Phone: 254-221-2900