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General NPI Number Information
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NPI Number | 1386046068
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Entity Type | Organization
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Legal Business Name | TRIPOD NEURODIAGNOSTICS PLLC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 100 MEDICAL PKWY STE 100
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City | LAKEWAY
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State | TX
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Zip | 78738-5621
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Country | US
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Telephone | 512-347-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 509 TERRACE MOUNTAIN DR
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-3639
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Country | US
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Telephone | 512-347-7463
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RICHARD WUPPERMAN
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Credential | MD
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Telephone | 512-347-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171R00000X
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Taxonomy Name | Interpreter
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License Number |
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License Number State |
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