MEDICARE: NEUROLOGIC PROTECTION SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	204R00000X	Electrodiagnostic Medicine Physician
2	2084N0400X	Neurology Physician
3	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
4	363A00000X	Physician Assistant
5	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1699271312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGIC PROTECTION SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6125 LUTHER LN #189
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6202
Country	:	US
Telephone Number	:	214-612-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 LUTHER LN #189
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6202
Country	:	US
Telephone Number	:	214-612-6518
Fax Number	:

Authorized Official
Title or Position	:	MDMS NPI COMPLIANCE OFFICER
Name	:	LIZETTE MORIN
Credential	:
Telephone Number	:	210-598-2801

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	09/24/2018

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