Provider Demographics
NPI:1437817541
Name:RIDGELEA NEUROMONITORING
Entity Type:Organization
Organization Name:RIDGELEA NEUROMONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-717-5802
Mailing Address - Street 1:PO BOX 703231
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-3231
Mailing Address - Country:US
Mailing Address - Phone:682-717-5802
Mailing Address - Fax:214-666-8386
Practice Address - Street 1:16633 DALLAS PKWY STE 125
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6816
Practice Address - Country:US
Practice Address - Phone:214-666-8386
Practice Address - Fax:214-666-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty