MEDICARE: VELOCITY EMG,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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1386820579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VELOCITY EMG,LLC

Provider Business Mailing Address
First Line	:	530 WELLS FARGO DR
Second Line	:	SUITE112
City	:	HOUSTON
State	:	TX
Zip	:	77090-4044
Country	:	US
Telephone Number	:	281-440-3500
Fax Number	:	281-440-3504

Provider Business Practice Location Address
First Line	:	530 WELLS FARGO DR
Second Line	:	SUITE112
City	:	HOUSTON
State	:	TX
Zip	:	77090-4044
Country	:	US
Telephone Number	:	281-440-3500
Fax Number	:	281-440-3504

Authorized Official
Title or Position	:	CEO
Name	:	MR. STEVEN PURDON
Credential	:	BBA,CNIM
Telephone Number	:	281-440-3500

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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