Provider Demographics
NPI:1578218244
Name:NEUROSCIENCE INSTITUTE OF LAREDO PLLC
Entity Type:Organization
Organization Name:NEUROSCIENCE INSTITUTE OF LAREDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-771-0622
Mailing Address - Street 1:5711 MCPHERSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5711 MCPHERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6838
Practice Address - Country:US
Practice Address - Phone:956-462-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty