Medical Provider Services LLC
NPI 1104582386 · Electrodiagnostic Medicine Physician · Ft Worth, TX
Medical Provider Services LLC is a Electrodiagnostic Medicine Physician organization in Ft Worth, TX (NPI 1104582386).
Provider details
- NPI number
- 1104582386
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gina Sullivan, Practice Administrator(903) 259-0550
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2021-11-12
- Last updated
- 2021-11-12
- Certified
- 2021-11-12
Frequently asked questions
- What is Medical Provider Services LLC's NPI number?
- Medical Provider Services LLC's National Provider Identifier (NPI) is 1104582386, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Medical Provider Services LLC?
- Medical Provider Services LLC is classified in the NPPES registry as Electrodiagnostic Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Medical Provider Services LLC located?
- Medical Provider Services LLC's practice location on file with NPPES is 111 Boland St Ste 211, Ft Worth, TX 76107-1265.
- What is Medical Provider Services LLC's phone number?
- The practice phone number listed in the NPPES registry for Medical Provider Services LLC is (817) 529-8488.
- Who is the authorized official for Medical Provider Services LLC?
- The authorized official listed on Medical Provider Services LLC's NPPES record is Gina Sullivan, Practice Administrator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Medical Provider Services LLC's NPI active?
- Yes — Medical Provider Services LLC's NPI (1104582386) is active in the NPPES registry as of the last update on 2021-11-12.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.