Provider Demographics
NPI:1487775177
Name:NEUROLOGY SEIZURE & SLEEP CLINIC
Entity type:Organization
Organization Name:NEUROLOGY SEIZURE & SLEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAROQUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:817-424-5900
Mailing Address - Street 1:2020 W STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8649
Mailing Address - Country:US
Mailing Address - Phone:817-424-5900
Mailing Address - Fax:214-496-0922
Practice Address - Street 1:2020 W STATE HIGHWAY 114
Practice Address - Street 2:SUITE 310
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8649
Practice Address - Country:US
Practice Address - Phone:817-424-5900
Practice Address - Fax:214-496-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28756Medicare UPIN