Provider Demographics
NPI:1114377223
Name:MISSOURI NEURODIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MISSOURI NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-995-8416
Mailing Address - Street 1:4545 FULLER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6530
Mailing Address - Country:US
Mailing Address - Phone:469-995-8416
Mailing Address - Fax:866-279-4704
Practice Address - Street 1:100 CHESTERFIELD BUSINESS PWKY
Practice Address - Street 2:STE. 200, OFFICE 238
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1271
Practice Address - Country:US
Practice Address - Phone:314-332-1340
Practice Address - Fax:866-279-4704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE FAMILY OF COMPANIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic