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General NPI Number Information
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NPI Number | 1023240751
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Entity Type | Organization
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Legal Business Name | MRS NEUROSURGICAL CLINIC
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 01/22/2012
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Provider Practice Location Address
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Address Line | 4001 W 15TH ST SUITE 260
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City | PLANO
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State | TX
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Zip | 75093-5841
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Country | US
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Telephone | 214-778-2530
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Fax | 214-778-2542
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Provider Business Mailing Address
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Address Line | PO BOX 262449
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City | PLANO
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State | TX
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Zip | 75026-2449
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Country | US
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Telephone | 214-778-2530
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Fax | 214-778-2542
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | MRS. SANDRA K HERRON
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Credential |
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Telephone | 214-778-2530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H3003
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License Number State | TX
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