MEDICARE: NEUROSOMNOLOGY PA

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	N0433	TX

General Provider Information

NPI Number	:	1972864007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSOMNOLOGY PA

Provider Business Mailing Address
First Line	:	5611 SILVERTHORN GLEN DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3517
Country	:	US
Telephone Number	:	281-808-7381
Fax Number	:	713-694-6067

Provider Business Practice Location Address
First Line	:	5611 SILVERTHORN GLEN DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3517
Country	:	US
Telephone Number	:	281-808-7381
Fax Number	:	713-694-6067

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. SANDRA J WILLIAMS
Credential	:
Telephone Number	:	281-808-7381

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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