MEDICARE: BARTON SPRINGS NEUROLOGY, PLLC

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	204R00000X	Electrodiagnostic Medicine Physician

General Provider Information

NPI Number	:	1689211211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTON SPRINGS NEUROLOGY, PLLC

Provider Business Mailing Address
First Line	:	12030 BANDERA RD # 108-1000
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12030 BANDERA RD # 108-1000
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4735
Country	:	US
Telephone Number	:	214-865-6310
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DOREEN SHINN
Credential	:
Telephone Number	:	214-865-6310

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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