Provider Demographics
NPI:1629482104
Name:NEUROSENTINEL PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:NEUROSENTINEL PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CABE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:888-824-1470
Mailing Address - Street 1:PO BOX 580469
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-0469
Mailing Address - Country:US
Mailing Address - Phone:888-824-1470
Mailing Address - Fax:832-864-2739
Practice Address - Street 1:1110 NASA PKWY STE 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3346
Practice Address - Country:US
Practice Address - Phone:888-824-1470
Practice Address - Fax:832-864-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory