Provider Demographics
NPI:1508359712
Name:GALEN NEURODIAGNOSTICS LLC
Entity type:Organization
Organization Name:GALEN NEURODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GODBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-653-3459
Mailing Address - Street 1:PO BOX 90421
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0421
Mailing Address - Country:US
Mailing Address - Phone:512-653-3459
Mailing Address - Fax:
Practice Address - Street 1:901 W 38TH ST STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1164
Practice Address - Country:US
Practice Address - Phone:512-992-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty