Homestead Neuro Diagnostics

Primary specialty

EEG TechnicianTaxonomy code 2472E0500X

Legal business name

HOMESTEAD NEURO DIAGNOSTICS

Practice address

8403 State Highway 151
Ste 104 #111
San Antonio, TX 78245-2199

Phone

(832) 469-1155

NPI assigned

Mar 28, 2016

Last updated

Mar 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clifton Albert Jacob Edwards, MHA, PMP, CPHQ

Title

Owner/Manager

Phone

(832) 469-1155

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1174985139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8403 STATE HIGHWAY 151",
            "address_2": "STE 104 #111",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782452199",
            "telephone_number": "832-469-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8403 STATE HIGHWAY 151",
            "address_2": "STE 104 #111",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782452199",
            "telephone_number": "832-469-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMESTEAD NEURO DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-28",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_middle_name": "ALBERT JACOB",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "832-469-1155",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA, PMP, CPHQ"
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "",
            "desc": "Technician, Other, EEG",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.