Provider Demographics
NPI:1538563283
Name:OLYMPIANEURO LLC
Entity type:Organization
Organization Name:OLYMPIANEURO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRESHON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-446-1491
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1191
Mailing Address - Country:US
Mailing Address - Phone:713-446-1491
Mailing Address - Fax:713-583-6635
Practice Address - Street 1:2938 WINCHASE BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1864
Practice Address - Country:US
Practice Address - Phone:713-446-1491
Practice Address - Fax:713-583-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty