1710312806 NPI number — ATLAS SURGICAL NEUROMONITORING, PLLC

Table of content: DR. EDWINA VIRGINIA JOHNSON DDS (NPI 1316049141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710312806 NPI number — ATLAS SURGICAL NEUROMONITORING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLAS SURGICAL NEUROMONITORING, 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:
1710312806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2016301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-6301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-324-5660
Provider Business Mailing Address Fax Number:
281-324-5679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 W BEDFRD EULES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76053-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-324-5660
Provider Business Practice Location Address Fax Number:
281-324-5679
Provider Enumeration Date:
09/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NEFF
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
817-485-5100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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