MEDICARE: NEURO-DIAGNOSTECHS LLC

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	247200000X	Other Technician
2	246ZE0500X	EEG Specialist/Technologist

General Provider Information

NPI Number	:	1770031536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO-DIAGNOSTECHS LLC

Provider Business Mailing Address
First Line	:	1319 RICHMOND AVE STE 66034
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5453
Country	:	US
Telephone Number	:	832-332-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 RICHMOND AVENUE
Second Line	:	SUITE 66034
City	:	HOUSTON
State	:	TX
Zip	:	77006-9998
Country	:	US
Telephone Number	:	832-332-3703
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRANT STAHL
Credential	:
Telephone Number	:	832-332-3703

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	06/27/2024

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