MEDICARE: N20 IOM

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	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1144730730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N20 IOM

Provider Business Mailing Address
First Line	:	10330 LAKE RD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1696
Country	:	US
Telephone Number	:	832-930-1000
Fax Number	:	832-941-1150

Provider Business Practice Location Address
First Line	:	10330 LAKE RD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1696
Country	:	US
Telephone Number	:	832-930-1000
Fax Number	:	832-941-1150

Authorized Official
Title or Position	:	CEO
Name	:	JOSE SOTO
Credential	:	CNIM
Telephone Number	:	832-930-1000

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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