Organization
GLOBAL BRAIN EEG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY L HOLLINGSWORTH (CEO)
(817) 328-3000
Entity
Organization
Contact information
Practice address
521 W SOUTHLAKE BLVD STE 150, SOUTHLAKE, TX 76092-6174
(817) 328-3000
(817) 328-3333
Mailing address
521 W SOUTHLAKE BLVD STE 150, SOUTHLAKE, TX 76092-6174
(817) 328-3000
(817) 328-3333
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409761001
—
TX
Enumeration date
01/31/2017
Last updated
07/27/2020
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