MEDICARE: NEUROLOGICAL SERVICES OF TEXAS, P.A.

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	174400000X	Specialist	E1506	TX

General Provider Information

NPI Number	:	1821266552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGICAL SERVICES OF TEXAS, P.A.

Provider Business Mailing Address
First Line	:	1001 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3021
Country	:	US
Telephone Number	:	817-334-7922
Fax Number	:	817-870-2144

Provider Business Practice Location Address
First Line	:	3115 FORT WORTH HWY
Second Line	:	SUITE 200
City	:	HUDSON OAKS
State	:	TX
Zip	:	76087-8720
Country	:	US
Telephone Number	:	817-596-0569
Fax Number	:	817-870-2144

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. SUSAN K BLUE
Credential	:	M.D.
Telephone Number	:	817-334-7922

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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