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General NPI Number Information
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NPI Number | 1750785705
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Entity Type | Organization
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Legal Business Name | LEGACY NEUROLOGY & SLEEP OF NORTH TEXAS
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 10369 BRADSHAW DR
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City | FORT WORTH
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State | TX
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Zip | 76108-6990
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Country | US
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Telephone | 817-500-3407
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Fax | 682-730-1808
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Provider Business Mailing Address
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Address Line | 10369 BRADSHAW DR
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City | FORT WORTH
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State | TX
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Zip | 76108-6990
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Country | US
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Telephone | 817-500-3407
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Fax | 682-730-1808
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. CHERYL N NICHOLS
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Credential | RPSGT
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Telephone | 817-500-3407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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