MEDICARE: KER ROCK ISLAND, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	204R00000X	Electrodiagnostic Medicine Physician
2	2084N0400X	Neurology Physician
3	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
4	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1861031783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KER ROCK ISLAND, PLLC

Provider Business Mailing Address
First Line	:	MSC 927 PO BOX 660707
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0707
Country	:	US
Telephone Number	:	469-334-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	15950 DALLAS PKWY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-6628
Country	:	US
Telephone Number	:	469-334-4307
Fax Number	:

Authorized Official
Title or Position	:	LEGAL OPERATIONS MANAGER
Name	:	FELICIA ALDERETE
Credential	:
Telephone Number	:	210-598-2801

Provider Enumeration Date	:	12/23/2019
Last Update Date	:	05/12/2021

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