Provider Demographics
NPI:1235404260
Name:PRICO HEALTH LLC
Entity Type:Organization
Organization Name:PRICO HEALTH LLC
Other - Org Name:ION NEURO-DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PROVIDENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:817-297-8446
Mailing Address - Street 1:787 E FM 1187 STE C
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4357
Mailing Address - Country:US
Mailing Address - Phone:817-297-8446
Mailing Address - Fax:866-693-2857
Practice Address - Street 1:787 E FM 1187 STE C
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4357
Practice Address - Country:US
Practice Address - Phone:817-297-8446
Practice Address - Fax:866-693-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0100X, 261QS1200X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic