=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679956536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID-CITIES MONITORING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2015
-----------------------------------------------------
Last Update Date | 11/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 N INDUSTRIAL BLVD SUITE 106
-----------------------------------------------------
City | EULESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76039-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-503-9585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 733188
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75373-3188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CHARLES C NEFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-485-5100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0600X
-----------------------------------------------------
Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------