Southlake Neuromonitoring LLC

NPI #1982172987 in Ft Worth, Texas

Provider Information

NPI Number: 1982172987
Entity Type: Organization
Organization Name: Southlake Neuromonitoring LLC
Primary Specialty: Electrodiagnostic Medicine
Enumeration Date: Nov 7, 2018
Last Updated: Nov 7, 2018

Practice Location

Address: 111 BOLAND ST STE 211
City: Ft Worth
State: Texas
ZIP Code: 76107-1265
Phone: (214) 269-3875

Authorized Official

Name: GINA SULLIVAN
Title: BILLING MANAGER
Phone: (214) 269-3875

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Electrodiagnostic Medicine	204R00000X	Primary

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