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General NPI Number Information
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NPI Number | 1629747753
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Entity Type | Organization
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Legal Business Name | OVERSITE NEURO
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 14983 BOAZ LN
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City | LINDALE
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State | TX
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Zip | 75771-4801
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Country | US
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Telephone | 972-896-1843
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Fax | 214-919-2560
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Provider Business Mailing Address
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Address Line | PO BOX 1620
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City | LINDALE
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State | TX
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Zip | 75771-1620
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Country | US
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Telephone | 972-896-1843
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Fax | 214-919-2560
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MARY JANE SEMICH
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Credential | CPC
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Telephone | 972-896-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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