Organization Active NPI

US Eeg, LLC

  • Physiological Laboratory
  • Dallas, TX
National Provider Identifier
1609433366
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
US EEG, LLC
Practice address
3100 Monticello Ave Ste 210
Dallas, TX 75205-3442
Phone
(817) 529-8500
Fax
(520) 335-8705
NPI assigned
May 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Mr. Gary W Joe
Title
Partner
Phone
(214) 415-7659

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

3100 Monticello Ave Ste 210
Dallas, TX 75205-3442

Mailing address

111 Boland St Ste 211
Fort Worth, TX 76107-1265
Phone (814) 529-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200420001870 TX Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1759711500 Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1559001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1609433366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BOLAND ST STE 211",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761071265",
            "telephone_number": "814-529-8500",
            "fax_number": "520-335-8705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MONTICELLO AVE STE 210",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752053442",
            "telephone_number": "817-529-8500",
            "fax_number": "520-335-8705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "US EEG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-28",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "JOE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "214-415-7659",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.