Provider Demographics
NPI:1134503527
Name:CAPITAL DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:CAPITAL DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:NEMER
Authorized Official - Suffix:III
Authorized Official - Credentials:CNIM
Authorized Official - Phone:972-480-4797
Mailing Address - Street 1:1402 OLD KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5249
Mailing Address - Country:US
Mailing Address - Phone:972-480-4797
Mailing Address - Fax:
Practice Address - Street 1:1402 OLD KNOLL DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5249
Practice Address - Country:US
Practice Address - Phone:972-480-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty