Provider Demographics
NPI:1982907143
Name:NEURO DIAGNOSTIC HOME SERVICES, LLC
Entity Type:Organization
Organization Name:NEURO DIAGNOSTIC HOME SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:469-831-7111
Mailing Address - Street 1:5904 S COOPER ST
Mailing Address - Street 2:SUITE 104-184
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4494
Mailing Address - Country:US
Mailing Address - Phone:469-831-7111
Mailing Address - Fax:
Practice Address - Street 1:1120 S FREEWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-5064
Practice Address - Country:US
Practice Address - Phone:469-831-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty