NPIMap

Organization Active NPI

Neurocare Centre of North Texas, PLLC

  • Neurology Physician
  • Southlake, TX
National Provider Identifier
1104344688
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
L2023 Issued in TX
Legal business name
NEUROCARE CENTRE OF NORTH TEXAS, PLLC
Practice address
731 E Southlake Blvd Ste 170
Southlake, TX 76092-6382
Phone
(817) 488-0100
Fax
(888) 217-2697
NPI assigned
Sep 5, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Simon Tan, MDNPI 1811001365
Title
Owner
Phone
(972) 877-9152

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X L2023 TX Primary
Clinical Neurophysiology Physician 2084N0600X L2023 TX
Neuromuscular Medicine (Psychiatry & Neurology) Physician 2084N0008X L2023 TX
Brain Injury Medicine (Psychiatry & Neurology) Physician 2084P0301X L2023 TX

Addresses

Primary practice location

731 E Southlake Blvd Ste 170
Southlake, TX 76092-6382

Mailing address

731 E Southlake Blvd Ste 170
Southlake, TX 76092-6382
Phone (817) 488-0100

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1104344688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD STE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926382",
            "telephone_number": "817-488-0100",
            "fax_number": "888-217-2697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD STE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926382",
            "telephone_number": "817-488-0100",
            "fax_number": "888-217-2697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROCARE CENTRE OF NORTH TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-877-9152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "L2023",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "TX",
            "license": "L2023",
            "primary": false
        },
        {
            "code": "2084N0008X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "TX",
            "license": "L2023",
            "primary": false
        },
        {
            "code": "2084P0301X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": "TX",
            "license": "L2023",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.