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NPI Code Detail

MEDICARE: NEUROLOGICAL SERVICES OF TEXAS, P.A.

MEDICARE: NEUROLOGICAL SERVICES OF TEXAS, P.A.
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
1174400000XSpecialistE1506TX

General Provider Information

NPI Number : 1285822775
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROLOGICAL SERVICES OF TEXAS, P.A.
Provider Business Mailing Address
First Line : 1001 WASHINGTON AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3021
Country : US
Telephone Number : 817-335-3510
Fax Number : 817-870-2144
Provider Business Practice Location Address
First Line : 1001 WASHINGTON AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3021
Country : US
Telephone Number : 817-335-3510
Fax Number : 817-870-2144
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : DR. SUSAN K. BLUE
Credential : M.D.
Telephone Number : 817-335-3510
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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Directions to “NEUROLOGICAL SERVICES OF TEXAS, P.A. ” Practice Location

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