Provider Demographics
NPI:1043770621
Name:INTEGRIS NEURO LLC
Entity Type:Organization
Organization Name:INTEGRIS NEURO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-944-2111
Mailing Address - Street 1:2012 JUSTIN RD STE 200-H
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7193
Mailing Address - Country:US
Mailing Address - Phone:877-944-2111
Mailing Address - Fax:877-492-1768
Practice Address - Street 1:2012 JUSTIN RD STE 200-H
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7193
Practice Address - Country:US
Practice Address - Phone:877-944-2111
Practice Address - Fax:877-492-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory