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General NPI Number Information
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NPI Number | 1104344688
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Entity Type | Organization
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Legal Business Name | NEUROCARE CENTRE OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 731 E SOUTHLAKE BLVD STE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6382
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Country | US
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Telephone | 817-488-0100
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Fax | 888-217-2697
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Provider Business Mailing Address
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Address Line | 731 E SOUTHLAKE BLVD STE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6382
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Country | US
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Telephone | 817-488-0100
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Fax | 888-217-2697
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIMON TAN
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Credential | MD
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Telephone | 972-877-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | L2023
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | L2023
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number | L2023
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L2023
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License Number State | TX
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