Provider Demographics
NPI:1992283485
Name:NEURODIAGNOSTICS TEX, LLC
Entity type:Organization
Organization Name:NEURODIAGNOSTICS TEX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-534-8812
Mailing Address - Street 1:4803 JEFFERSON AVENUE
Mailing Address - Street 2:SUITE 32
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1143
Mailing Address - Country:US
Mailing Address - Phone:972-724-5446
Mailing Address - Fax:972-724-5447
Practice Address - Street 1:4803 JEFFERSON AVENUE
Practice Address - Street 2:SUITE 32
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1143
Practice Address - Country:US
Practice Address - Phone:972-724-5446
Practice Address - Fax:972-724-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty