1114318797 NPI number — NEUROPHYSIOLOGY PROFESSIONAL ASSOCIATES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114318797 NPI number — NEUROPHYSIOLOGY PROFESSIONAL ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROPHYSIOLOGY PROFESSIONAL ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114318797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6125 LUTHER LN
Provider Second Line Business Mailing Address:
SUITE 442
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75225-6202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-536-1647
Provider Business Mailing Address Fax Number:
214-580-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6116 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75206-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-536-1647
Provider Business Practice Location Address Fax Number:
214-580-7600
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JENEVEIN
Authorized Official First Name:
NOLAN
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-738-4961

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  H2492 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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