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General NPI Number Information
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NPI Number | 1104055342
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Entity Type | Organization
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Legal Business Name | NEURODIAGNOSTIC CENTER OF TEXAS ASSOCIATES P A
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 7920 PRESTON RD STE 600
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City | PLANO
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State | TX
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Zip | 75024-2343
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Country | US
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Telephone | 866-620-5987
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 703324
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City | DALLAS
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State | TX
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Zip | 75370-3324
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Country | US
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Telephone | 940-389-7664
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. FRANCES A GRANT
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Credential |
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Telephone | 580-276-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J8958
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | D2622
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License Number State | TX
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