Omni Eeg Lab, Inc.

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

OMNI EEG LAB, INC.

Practice address

6162 E Mockingbird LN
Suite 210a
Dallas, TX 75214-2697

Phone

(877) 334-5227

Fax

(214) 550-8215

NPI assigned

May 17, 2011

Organization subpart

No

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

Authorized official

Name

Julian Tilleman, R. EEG T.

Title

President

Phone

(877) 334-5227

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nolan Bruce Jenevein, M.D.

  • Neurology Physician
  • Dallas, TX
  • NPI 1346217163
  NPD

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1366735771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6162 E MOCKINGBIRD LN",
            "address_2": "SUITE 210A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752142697",
            "telephone_number": "877-334-5227",
            "fax_number": "214-550-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6162 E MOCKINGBIRD LN",
            "address_2": "SUITE 210A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752142697",
            "telephone_number": "877-334-5227",
            "fax_number": "214-550-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI EEG LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "TILLEMAN",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "877-334-5227",
        "authorized_official_credential": "R. EEG T."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in Dallas, TX
• Providers in Dallas, TX by specialty
• Physiological Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.