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General NPI Number Information
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NPI Number | 1730458381
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Entity Type | Organization
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Legal Business Name | NEURIOM, PLLC
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 4007 MCCULLOUGH AVE #243
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City | SAN ANTONIO
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State | TX
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Zip | 78212
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Country | US
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Telephone | 210-714-5534
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Fax | 210-598-2815
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Provider Business Mailing Address
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Address Line | 4007 MCCULLOUGH AVE #243
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City | SAN ANTONIO
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State | TX
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Zip | 78212
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Country | US
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Telephone | 210-714-5534
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Fax | 210-566-1330
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Authorized Official
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Title or Position | ENROLLMENT COMPLIANCE OFFICER
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Name | ALISSA FISHER
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Credential |
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Telephone | 210-598-4240
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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 | 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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