Provider Demographics
NPI:1093218638
Name:NEUROSHIELD IOM, LLC
Entity Type:Organization
Organization Name:NEUROSHIELD IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CNIM
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURDON
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:832-585-3897
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1789
Mailing Address - Country:US
Mailing Address - Phone:281-346-3480
Mailing Address - Fax:281-940-8606
Practice Address - Street 1:803 SPRING SOURCE PL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7077
Practice Address - Country:US
Practice Address - Phone:832-585-3897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty