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General NPI Number Information
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NPI Number | 1568982148
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Entity Type | Organization
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Legal Business Name | GLOBAL BRAIN EEG
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 521 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6173
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Country | US
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Telephone | 817-328-3000
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Fax | 817-328-3333
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Provider Business Mailing Address
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Address Line | 521 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6173
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Country | US
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Telephone | 817-328-3000
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Fax | 817-328-3333
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Authorized Official
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Title or Position | OWNER
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Name | HEIDI DENISE HOLLINGSWORH
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Credential |
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Telephone | 817-798-7763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State | TX
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