Healthcare Provider Details

I. General information

NPI: 1144512914
Provider Name (Legal Business Name): GLOBAL NEURO-DIAGNOSTICS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 BOURBON ST STE 100
FREDERICKSBURG VA
22408-7333
US

IV. Provider business mailing address

1278 JUSTIN RD STE 109
LEWISVILLE TX
75077-2200
US

V. Phone/Fax

Practice location:
  • Phone: 866-848-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JANICE K SHOCK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 866-848-2522