MEDICARE: SYNAPSE DIAGNOSTICS INC.

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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1053810226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNAPSE DIAGNOSTICS INC.

Provider Business Mailing Address
First Line	:	PO BOX 734545
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-4545
Country	:	US
Telephone Number	:	210-598-5697
Fax Number	:

Provider Business Practice Location Address
First Line	:	4590 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2073
Country	:	US
Telephone Number	:	210-545-3713
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN KIESER
Credential	:
Telephone Number	:	210-598-5697

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	08/11/2020

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