Basic Information
| Provider Information | |||||||||
| NPI: | 1366991457 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ECHOLS | ||||||||
| FirstName: | IDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9777 W GULF BANK RD | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770403132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326930143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16131 N. ELDRIDGE PKWY SUITE 200 | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819705900 | ||||||||
| FaxNumber: | 2817905913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2016 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.