Provider Demographics
NPI:1891086310
Name:NEURO MEDIX INC
Entity type:Organization
Organization Name:NEURO MEDIX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISON MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-462-1285
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1288
Mailing Address - Country:US
Mailing Address - Phone:281-462-1285
Mailing Address - Fax:
Practice Address - Street 1:9153 WAGNER RIVER CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VLY
Practice Address - State:CA
Practice Address - Zip Code:92708-6449
Practice Address - Country:US
Practice Address - Phone:281-462-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty