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NPI Code Detail

MEDICARE: INTEGRIS NEURO LLC

MEDICARE: INTEGRIS NEURO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1043770621
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRIS NEURO LLC
Provider Business Mailing Address
First Line : 2012 JUSTIN RD STE 200-H
Second Line :
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-7193
Country : US
Telephone Number : 877-944-2111
Fax Number : 877-492-1768
Provider Business Practice Location Address
First Line : 2012 JUSTIN RD STE 200-H
Second Line :
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-7193
Country : US
Telephone Number : 877-944-2111
Fax Number : 877-492-1768
Authorized Official
Title or Position : OWNER
Name : STEVEN CHARLES ESTES
Credential :
Telephone Number : 877-944-2111
Provider Enumeration Date : 03/21/2019
Last Update Date : 01/19/2020

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Directions to “INTEGRIS NEURO LLC ” Practice Location

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