Healthcare Provider Details

I. General information

NPI: 1467583682
Provider Name (Legal Business Name): PREMIER NEURODIAGNOSTIC SERVICES OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 BELKNAP RD SUITE 114
SUGAR LAND TX
77478-1102
US

IV. Provider business mailing address

10055 BELKNAP RD SUITE 114
SUGAR LAND TX
77478-1102
US

V. Phone/Fax

Practice location:
  • Phone: 281-495-5966
  • Fax: 281-495-5799
Mailing address:
  • Phone: 281-495-5966
  • Fax: 281-495-5799

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: JODY E DEVINE
Title or Position: ADMINISTRATOR
Credential: B.S.
Phone: 281-495-5970