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General NPI Number Information
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NPI Number | 1912183641
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Entity Type | Organization
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Legal Business Name | NEUROLOGY AND ELECTROMYOGRAPHY CLINIC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 4201 MARATHON BLVD STE 304
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City | AUSTIN
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State | TX
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Zip | 78756-3436
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Country | US
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Telephone | 512-371-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 MARATHON BLVD STE 304
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City | AUSTIN
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State | TX
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Zip | 78756-3410
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Country | US
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Telephone | 512-371-1200
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | GARY CAMPBELL
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Credential |
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Telephone | 512-674-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L2112
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License Number State | TX
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