Provider Demographics
NPI:1316403959
Name:VIVID NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:VIVID NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-236-5922
Mailing Address - Street 1:2245 N LOOP 336 W STE B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 MEDICAL CENTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2928
Practice Address - Country:US
Practice Address - Phone:936-756-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty