Provider Demographics
NPI:1538304449
Name:TEXAS NEURODIAGNOSTIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TEXAS NEURODIAGNOSTIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:832-912-8603
Mailing Address - Street 1:1106 S FRIENDSWOOD DR STE A-2
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5497
Mailing Address - Country:US
Mailing Address - Phone:832-912-8603
Mailing Address - Fax:832-912-8616
Practice Address - Street 1:1106 S FRIENDSWOOD DR STE A-2
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5497
Practice Address - Country:US
Practice Address - Phone:832-912-8603
Practice Address - Fax:832-912-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX731789000OtherDOL
TX00G8Z3OtherBCBS RECORD ID
TXP01425146OtherRR MEDICARE