Provider Demographics
NPI:1083636070
Name:POTENTIAL MEDICAL SERVICE
Entity Type:Organization
Organization Name:POTENTIAL MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-698-8500
Mailing Address - Street 1:2255 RIDGE RD
Mailing Address - Street 2:STE 303
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5155
Mailing Address - Country:US
Mailing Address - Phone:469-698-8500
Mailing Address - Fax:469-698-8504
Practice Address - Street 1:2255 RIDGE RD
Practice Address - Street 2:STE 303
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5155
Practice Address - Country:US
Practice Address - Phone:469-698-8500
Practice Address - Fax:469-698-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty