MEDICARE: NEURO ANALYSIS DIAGNOSTICS, 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	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780818740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO ANALYSIS DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	20403 UNIVERSITY BLVD
Second Line	:	SUITE #300
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3558
Country	:	US
Telephone Number	:	281-302-5983
Fax Number	:	832-365-6065

Provider Business Practice Location Address
First Line	:	20403 UNIVERSITY BLVD
Second Line	:	SUITE #300
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3558
Country	:	US
Telephone Number	:	281-302-5983
Fax Number	:	832-365-6065

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIM C ALDRIDGE
Credential	:	RRT
Telephone Number	:	281-302-5983

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	06/02/2011

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