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General NPI Number Information
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NPI Number | 1558314567
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Entity Type | Organization
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Legal Business Name | NEURODIAGNOSTIC TEX, LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1356 OLD CREEK DR
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City | TYLER
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State | TX
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Zip | 75703-7642
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Country | US
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Telephone | 903-534-0809
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Fax | 903-939-9149
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Provider Business Mailing Address
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Address Line | PO BOX 1455
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City | WHITEHOUSE
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State | TX
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Zip | 75791-1455
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Country | US
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Telephone | 903-534-0809
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Fax | 903-939-9149
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CATHERINE BOLDERY
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Credential |
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Telephone | 903-534-0809
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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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