Provider Demographics
NPI:1538663125
Name:SYNERGIST MONITORING TEXAS LLC
Entity Type:Organization
Organization Name:SYNERGIST MONITORING TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-412-5299
Mailing Address - Street 1:PO BOX 5487
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5487
Mailing Address - Country:US
Mailing Address - Phone:833-613-9084
Mailing Address - Fax:
Practice Address - Street 1:5001 ROWLETT RD STE 300
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:972-412-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty