MEDICARE: NEUROINTEGRITY DIAGNOSTICS, 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
1	246ZE0500X	EEG Specialist/Technologist	N0125	TX
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	N0125	TX

General Provider Information

NPI Number	:	1467758052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROINTEGRITY DIAGNOSTICS, P.A.

Provider Business Mailing Address
First Line	:	12337 JONES RD.
Second Line	:	SUITE 427
City	:	HOUSTON
State	:	TX
Zip	:	77070-4951
Country	:	US
Telephone Number	:	832-912-8603
Fax Number	:	832-912-8616

Provider Business Practice Location Address
First Line	:	12337 JONES RD
Second Line	:	SUITE 427
City	:	HOUSTON
State	:	TX
Zip	:	77070-4800
Country	:	US
Telephone Number	:	832-912-8603
Fax Number	:	832-912-8616

Authorized Official
Title or Position	:	CFO
Name	:	MR. MICHAEL P. HERMAN
Credential	:	CPA
Telephone Number	:	832-912-8603

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	08/06/2014

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Directions to “NEUROINTEGRITY DIAGNOSTICS, P.A. ” Practice Location

Language	Start Address	Practice Location

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