Active NPI
Momentum Neuromonitoring LLC
- Electrodiagnostic Medicine Physician
- Fort Worth, TX
National Provider Identifier
1700504289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Electrodiagnostic Medicine Physician
- Legal business name
- MOMENTUM NEUROMONITORING LLC
- Practice address
- 111 Boland St Ste 211
Ft Worth, TX 76107-1265 - Phone
- (817) 529-8488
- Fax
- (903) 328-6568
- NPI assigned
- Aug 19, 2022
- Last updated
- Aug 19, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gina Sullivan
- Title
- Practice Administrator
- Phone
- (903) 259-0550
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Electrodiagnostic Medicine Physician | 204R00000X | NU | Primary |
Addresses
Primary practice location
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Mailing address
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Phone (817) 529-8488
National Provider Directory
National Provider DirectoryPractitioners & 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.
-
- Physician Office Based Coding Specialist
- Caddo Mills, TX
- NPI 1710506100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660867200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1660867200000",
"number": "1700504289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 BOLAND ST STE 211",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761071265",
"telephone_number": "817-529-8488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 BOLAND ST STE 211",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761071265",
"telephone_number": "817-529-8488",
"fax_number": "903-328-6568"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOMENTUM NEUROMONITORING LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-08-19",
"last_updated": "2022-08-19",
"certification_date": "2022-08-19",
"status": "A",
"authorized_official_last_name": "SULLIVAN",
"authorized_official_first_name": "GINA",
"authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
"authorized_official_telephone_number": "903-259-0550"
},
"taxonomies": [
{
"code": "204R00000X",
"taxonomy_group": "",
"desc": "Electrodiagnostic Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.