Healthcare Provider Details

I. General information

NPI: 1619640828
Provider Name (Legal Business Name): ALTERA NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 FM 359 RD STE 17
RICHMOND TX
77406-7682
US

IV. Provider business mailing address

PO BOX 2190
SUGAR LAND TX
77487-2190
US

V. Phone/Fax

Practice location:
  • Phone: 281-265-1776
  • Fax: 281-265-1805
Mailing address:
  • Phone: 281-265-1776
  • Fax: 281-265-1805

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: PHYLLIS BENEFIELD
Title or Position: PRESIDENT
Credential:
Phone: 713-899-5822