MEDICARE: WEBSTER DIAGNOSTICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1154840908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBSTER DIAGNOSTICS, PLLC

Provider Business Mailing Address
First Line	:	18333 EGRET BAY BLVD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3200
Country	:	US
Telephone Number	:	281-333-1300
Fax Number	:	281-333-1303

Provider Business Practice Location Address
First Line	:	18333 EGRET BAY BLVD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3200
Country	:	US
Telephone Number	:	281-333-1300
Fax Number	:	281-333-1303

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANGELA BALES
Credential	:
Telephone Number	:	281-333-1300

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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