Provider Demographics
NPI:1417434523
Name:SPECTRUM NEURO LP
Entity Type:Organization
Organization Name:SPECTRUM NEURO LP
Other - Org Name:SPECTRUM NEURO LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-225-5367
Mailing Address - Street 1:3333 LAKE ST UNIT 7H
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2170
Mailing Address - Country:US
Mailing Address - Phone:713-225-5367
Mailing Address - Fax:
Practice Address - Street 1:3333 LAKE ST UNIT 7H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-2170
Practice Address - Country:US
Practice Address - Phone:713-225-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID