Provider Demographics
NPI:1255126272
Name:COWTOWN HEADACHE CENTER AND NEURODIAGNOSTICS, PLLC
Entity type:Organization
Organization Name:COWTOWN HEADACHE CENTER AND NEURODIAGNOSTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'CARROLL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:817-894-0195
Mailing Address - Street 1:7001 TRAIL BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-6668
Mailing Address - Country:US
Mailing Address - Phone:817-894-0195
Mailing Address - Fax:
Practice Address - Street 1:1200 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5653
Practice Address - Country:US
Practice Address - Phone:817-592-8427
Practice Address - Fax:833-630-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty