Provider Demographics
NPI:1154671113
Name:BK NEUROMONITORING, PLLC
Entity Type:Organization
Organization Name:BK NEUROMONITORING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-4240
Mailing Address - Street 1:25 HIGHLAND PARK VILLAGE
Mailing Address - Street 2:SUITE 100 #566
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:469-283-0565
Mailing Address - Fax:210-566-1330
Practice Address - Street 1:25 HIGHLAND PARK VILLAGE
Practice Address - Street 2:SUITE 100 #566
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:469-283-0565
Practice Address - Fax:210-566-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty