MEDICARE: NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC

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	2084N0400X	Neurology Physician	L2694	TX

General Provider Information

NPI Number	:	1689985038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC

Provider Business Mailing Address
First Line	:	621 PALO DURO DR
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-6009
Country	:	US
Telephone Number	:	817-886-0369
Fax Number	:	817-268-9011

Provider Business Practice Location Address
First Line	:	4931 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2787
Country	:	US
Telephone Number	:	817-886-0369
Fax Number	:	817-268-9011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MADHAVI THOMAS
Credential	:	MD
Telephone Number	:	817-886-0369

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/07/2022

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