MEDICARE: KIM RENEE KOLLS R-EEG-T, CNIM

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	246ZE0500X	EEG Specialist/Technologist	3404	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3407	OTHER	TX	R-EEG-T

General Provider Information

NPI Number	:	1831195312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM RENEE KOLLS R-EEG-T, CNIM

Provider Business Mailing Address
First Line	:	25 HIGHLAND PARK VLG
Second Line	:	STE 100-225
City	:	DALLAS
State	:	TX
Zip	:	75205
Country	:	US
Telephone Number	:	214-536-1647
Fax Number	:	214-580-7600

Provider Business Practice Location Address
First Line	:	25 HIGHLAND PARK VLG STE 100-225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-2789
Country	:	US
Telephone Number	:	214-536-1647
Fax Number	:	214-580-7600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2022

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