Provider Demographics
NPI:1497832463
Name:NEURODIAGNOSTIC LABS OF SAN ANTONIO INC
Entity Type:Organization
Organization Name:NEURODIAGNOSTIC LABS OF SAN ANTONIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-692-3436
Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:STE 640
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3810
Mailing Address - Country:US
Mailing Address - Phone:210-692-3436
Mailing Address - Fax:210-614-3316
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:STE 640
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3810
Practice Address - Country:US
Practice Address - Phone:210-692-3436
Practice Address - Fax:210-614-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084B392Medicaid
00R611Medicare ID - Type Unspecified