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General NPI Number Information
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NPI Number | 1083636070
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Entity Type | Organization
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Legal Business Name | POTENTIAL MEDICAL SERVICE
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2255 RIDGE RD STE 303
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City | ROCKWALL
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State | TX
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Zip | 75087-5155
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Country | US
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Telephone | 469-698-8500
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Fax | 469-698-8504
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Provider Business Mailing Address
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Address Line | 2255 RIDGE RD STE 303
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City | ROCKWALL
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State | TX
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Zip | 75087-5155
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Country | US
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Telephone | 469-698-8500
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Fax | 469-698-8504
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. VERONICA D SANDERS
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Credential |
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Telephone | 469-698-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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