Provider Demographics
NPI:1528196458
Name:PLATINUM NEURODIAGNOSTICS
Entity Type:Organization
Organization Name:PLATINUM NEURODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:THIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-964-2106
Mailing Address - Street 1:5535 MEMORIAL DR
Mailing Address - Street 2:SUITE F #414
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8021
Mailing Address - Country:US
Mailing Address - Phone:800-964-2106
Mailing Address - Fax:888-545-4108
Practice Address - Street 1:3986 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6847
Practice Address - Country:US
Practice Address - Phone:800-964-2106
Practice Address - Fax:888-545-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service