Basic Information
| Provider Information | |||||||||
| NPI: | 1144653429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA NEURO TECH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1651 | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775321651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814627684 | ||||||||
| FaxNumber: | 8888325078 | ||||||||
| Practice Location | |||||||||
| Address1: | 1207 RUNNING BEAR TRL | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775323618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814627684 | ||||||||
| FaxNumber: | 8888325078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2013 | ||||||||
| LastUpdateDate: | 08/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | CLEARY | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2814627684 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.