Provider Demographics
NPI:1528598521
Name:MBB NEUROMONITORING LLC
Entity Type:Organization
Organization Name:MBB NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:281-772-9023
Mailing Address - Street 1:3526 LAKEVIEW PKWY # B132
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4176
Mailing Address - Country:US
Mailing Address - Phone:972-412-5299
Mailing Address - Fax:469-453-3374
Practice Address - Street 1:5001 ROWLETT RD # 7
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-3602
Practice Address - Country:US
Practice Address - Phone:972-412-5299
Practice Address - Fax:469-453-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2340246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1207OtherR. EP T.
TX2340OtherCNIM