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NPI Code Detail

MEDICARE: NEURODIAGNOSTICS TEX INC

MEDICARE: NEURODIAGNOSTICS TEX INC
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
1204R00000XElectrodiagnostic Medicine Physician

General Provider Information

NPI Number : 1841691763
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEURODIAGNOSTICS TEX INC
Provider Business Mailing Address
First Line : PO BOX 1455
Second Line :
City : WHITEHOUSE
State : TX
Zip : 75791-1455
Country : US
Telephone Number : 903-534-0809
Fax Number : 903-939-9149
Provider Business Practice Location Address
First Line : 1356 OLD CREEK DR
Second Line :
City : TYLER
State : TX
Zip : 75703-7642
Country : US
Telephone Number : 903-534-0809
Fax Number : 903-939-9149
Authorized Official
Title or Position : PRESIDENT/CEO
Name : CATHERINE BOLDERY
Credential :
Telephone Number : 903-534-0809
Provider Enumeration Date : 09/10/2014
Last Update Date : 09/04/2024

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Directions to “NEURODIAGNOSTICS TEX INC ” Practice Location

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