MEDICARE: IMPULSE DIAGNOSTICS TX 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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	942	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	P6398	TX

General Provider Information

NPI Number	:	1881999654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPULSE DIAGNOSTICS TX INC

Provider Business Mailing Address
First Line	:	4402 VANCE JACKSON RD STE 144
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5336
Country	:	US
Telephone Number	:	210-481-9032
Fax Number	:	210-568-4433

Provider Business Practice Location Address
First Line	:	4402 VANCE JACKSON RD STE 144
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5336
Country	:	US
Telephone Number	:	210-481-9032
Fax Number	:	210-568-4433

Authorized Official
Title or Position	:	CEO
Name	:	EUGENIA ELISSEEV
Credential	:
Telephone Number	:	210-878-7372

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	11/18/2014

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Directions to “IMPULSE DIAGNOSTICS TX INC ” Practice Location

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