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General NPI Number Information
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NPI Number | 1528196458
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Entity Type | Organization
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Legal Business Name | PLATINUM NEURODIAGNOSTICS
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 3986 DOWLEN RD
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City | BEAUMONT
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State | TX
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Zip | 77706-6847
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Country | US
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Telephone | 800-964-2106
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Fax | 888-545-4108
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Provider Business Mailing Address
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Address Line | 5535 MEMORIAL DR SUITE F #414
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City | HOUSTON
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State | TX
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Zip | 77007-8021
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Country | US
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Telephone | 800-964-2106
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Fax | 888-545-4108
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG A THIRY
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Credential | D.O.
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Telephone | 800-964-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | TX
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