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NPI Code Detail

MEDICARE: PROFESSIONAL MEDICAL MONITORING

MEDICARE: PROFESSIONAL MEDICAL MONITORING
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
1204R00000XElectrodiagnostic Medicine Physician

General Provider Information

NPI Number : 1568323921
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL MEDICAL MONITORING
Provider Business Mailing Address
First Line : DEPT 880951 PO BOX 29650
Second Line :
City : PHOENIX
State : AZ
Zip : 85038-0951
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4500 ELDORADO PKWY STE 3400
Second Line :
City : MCKINNEY
State : TX
Zip : 75070-2760
Country : US
Telephone Number : 801-808-9538
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : BRAD BEACH
Credential :
Telephone Number : 801-808-9538
Provider Enumeration Date : 11/24/2025
Last Update Date : 11/24/2025

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Directions to “PROFESSIONAL MEDICAL MONITORING ” Practice Location

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