Provider Demographics
NPI:1780818740
Name:NEURO ANALYSIS DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:NEURO ANALYSIS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:281-302-5983
Mailing Address - Street 1:20403 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3558
Mailing Address - Country:US
Mailing Address - Phone:281-302-5983
Mailing Address - Fax:832-365-6065
Practice Address - Street 1:20403 UNIVERSITY BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3558
Practice Address - Country:US
Practice Address - Phone:281-302-5983
Practice Address - Fax:832-365-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217530901Medicaid
TXFTS255Medicare PIN