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NPI Code Detail

MEDICARE: OVERSITE NEURO

MEDICARE: OVERSITE NEURO
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
12084N0600XClinical Neurophysiology Physician

General Provider Information

NPI Number : 1629747753
Entity Type Code : Organization
Provider Name (Legal Business Name) : OVERSITE NEURO
Provider Business Mailing Address
First Line : PO BOX 1620
Second Line :
City : LINDALE
State : TX
Zip : 75771-1620
Country : US
Telephone Number : 972-896-1843
Fax Number : 214-919-2560
Provider Business Practice Location Address
First Line : 14983 BOAZ LN
Second Line :
City : LINDALE
State : TX
Zip : 75771-4801
Country : US
Telephone Number : 972-896-1843
Fax Number : 214-919-2560
Authorized Official
Title or Position : OWNER/CEO
Name : MARY JANE SEMICH
Credential : CPC
Telephone Number : 972-896-1843
Provider Enumeration Date : 09/11/2021
Last Update Date : 03/04/2026

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Directions to “OVERSITE NEURO ” Practice Location

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