Provider Demographics
NPI:1568070647
Name:NORTH TEXAS NEURODIAGNOSTICS AND IMAGING LLC
Entity Type:Organization
Organization Name:NORTH TEXAS NEURODIAGNOSTICS AND IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-212-5321
Mailing Address - Street 1:PO BOX 6529
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5114
Mailing Address - Country:US
Mailing Address - Phone:844-212-5321
Mailing Address - Fax:214-594-9559
Practice Address - Street 1:5228 VILLAGE CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4431
Practice Address - Country:US
Practice Address - Phone:844-212-5321
Practice Address - Fax:214-594-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty