Organization
NEUROLOGY AND ELECTROMYOGRAPHY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY CAMPBELL (ACCOUNT MANAGER)
(512) 674-9002
Entity
Organization
Contact information
Practice address
4201 MARATHON BLVD, STE 304, AUSTIN, TX 78756-3436
(512) 371-1200
Mailing address
4201 MARATHON BLVD, STE 304, AUSTIN, TX 78756-3410
(512) 371-1200
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
L2112
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00579T
BCBS
TX
05
—
155764701
—
TX
Enumeration date
01/11/2008
Last updated
12/19/2011
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