1255126272 NPI number — COWTOWN HEADACHE CENTER AND NEURODIAGNOSTICS, PLLC

Table of content: (NPI 1255126272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255126272 NPI number — COWTOWN HEADACHE CENTER AND NEURODIAGNOSTICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COWTOWN HEADACHE CENTER AND NEURODIAGNOSTICS, 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:
1255126272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7001 TRAIL BLUFF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANBURY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76048-6668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-894-0195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MEDICAL PLAZA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048-5653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-592-8427
Provider Business Practice Location Address Fax Number:
833-630-0542
Provider Enumeration Date:
04/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
O'CARROLL
Authorized Official First Name:
PETER
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-894-0195

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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