Provider Demographics
NPI:1922437839
Name:SPOTTED BASS NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:SPOTTED BASS NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-468-9467
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:STE 206
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-468-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty