Organization Active NPI

Momentum Neuromonitoring LLC

  • Electrodiagnostic Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1700504289
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X
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, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Authorized official

Name
Gina SullivanNPI 1710506100
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)CodeLicenseStatePrimary
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 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": "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.

Verify at the official NPI Registry.