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General NPI Number Information
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NPI Number | 1699271312
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Entity Type | Organization
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Legal Business Name | NEUROLOGIC PROTECTION SERVICES, PLLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 6125 LUTHER LN #189
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City | DALLAS
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State | TX
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Zip | 75225-6202
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Country | US
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Telephone | 214-612-6518
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Fax |
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Provider Business Mailing Address
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Address Line | 6125 LUTHER LN #189
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City | DALLAS
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State | TX
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Zip | 75225-6202
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Country | US
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Telephone | 214-612-6518
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Fax |
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Authorized Official
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Title or Position | MDMS NPI COMPLIANCE OFFICER
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Name | LIZETTE MORIN
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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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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