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General NPI Number Information
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NPI Number | 1538536446
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Entity Type | Organization
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Legal Business Name | EAST TEXAS SPINAL MONITORING, PLLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 22999 US-59 SUITE 220
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City | KINGWOOD
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State | TX
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Zip | 77339
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Country | US
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Telephone | 832-998-8221
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Fax | 210-598-7268
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Provider Business Mailing Address
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Address Line | MSC 545 PO BOX 660046
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City | DALLAS
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State | TX
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Zip | 75266-0046
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Country | US
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Telephone | 832-998-8221
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Fax | 210-598-7268
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Authorized Official
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Title or Position | LEGAL OPERATIONS MANAGER
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Name | FELICIA ALDERETE
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Credential |
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Telephone | 210-598-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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