Eagle Mountain Ancillaries LLC

NPI #1699220087 in Ft Worth, Texas

Provider Information

NPI Number: 1699220087
Entity Type: Organization
Organization Name: Eagle Mountain Ancillaries LLC
Primary Specialty: Electrodiagnostic Medicine
Enumeration Date: Aug 16, 2016
Last Updated: Aug 16, 2016

Practice Location

Address: 111 BOLAND ST
Address 2: 211
City: Ft Worth
State: Texas
ZIP Code: 76107-1263
Phone: (214) 269-3875

Authorized Official

Name: PAUL SCHULMAN
Title: MANAGER
Phone: (214) 315-6432

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Electrodiagnostic Medicine	204R00000X	Primary

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