Provider Demographics
NPI:1043763493
Name:BRAINHERTZ NEURODIAGNOSTIC LLC
Entity Type:Organization
Organization Name:BRAINHERTZ NEURODIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-490-1270
Mailing Address - Street 1:2700 WHISPERING OAKS CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8243
Mailing Address - Country:US
Mailing Address - Phone:214-437-1932
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD STE 416
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2420
Practice Address - Country:US
Practice Address - Phone:214-437-1932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty