Basic Information
| Provider Information | |||||||||
| NPI: | 1679827844 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SCHWEITZER | ||||||||
| FirstName: | FORREST | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | BA CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4808 FAIRMONT PKWY # 404 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775053722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816730222 | ||||||||
| FaxNumber: | 8888241470 | ||||||||
| Practice Location | |||||||||
| Address1: | 4808 FAIRMONT PKWY # 404 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775053722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816730222 | ||||||||
| FaxNumber: | 8888241470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | CNIM 2565 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
ID Information
| ID | Type | State | Issuer | Description | CNIM 2565 | 01 | AMERICAN BOARD OF REGISTERED EEG AND EP TECHNOLOGISTS | OTHER |