Basic Information
| Provider Information | |||||||||
| NPI: | 1467583682 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER NEURODIAGNOSTIC SERVICES OF TEXAS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIERE DIAGNOSTIC SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10055 BELKNAP RD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774781102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814955966 | ||||||||
| FaxNumber: | 2814955799 | ||||||||
| Practice Location | |||||||||
| Address1: | 10055 BELKNAP RD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774781102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814955966 | ||||||||
| FaxNumber: | 2814955799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DEVINE | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2814955970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | B.S. | ||||||||
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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.