Organization
LEGACY NEUROLOGICAL MONITORING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM ALLEN SULLIVAN JR. (OWNER)
(972) 403-1938
Entity
Organization
Contact information
Practice address
2419 COIT RD, SUITE 133, PLANO, TX 75075-3731
(972) 403-1702
(972) 403-1709
Mailing address
PO BOX 835390, RICHARDSON, TX 75083-5390
(972) 403-1938
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689677056
MICHAEL SEALS NPI
—
01
—
OA3498
MEDICARE GROUP PTAN
—
Enumeration date
01/27/2009
Last updated
02/17/2011
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