1154639334 NPI number — SOUTH TEXAS NEURODIAGNOSTICS LLC

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 1154639334 NPI number — SOUTH TEXAS NEURODIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS NEURODIAGNOSTICS LLC
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:
1154639334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3621 GULL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-4788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3621 GULL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-4788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-739-5670
Provider Business Practice Location Address Fax Number:
956-688-5852
Provider Enumeration Date:
09/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NASSIFF
Authorized Official First Name:
ALONZO
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
956-739-5670

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X , with the licence number:  492 , 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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