1962527317 NPI number — NEURAXIS MONITORING GROUP, LP

Table of content: (NPI 1962527317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962527317 NPI number — NEURAXIS MONITORING GROUP, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEURAXIS MONITORING GROUP, LP
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:
1962527317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT AT 952918
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31192-2918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-845-4595
Provider Business Mailing Address Fax Number:
866-845-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 SPURS LANE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-845-4595
Provider Business Practice Location Address Fax Number:
866-845-8810
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
985-809-6067

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)

  • Identifier: 884ML . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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