MEDICARE: ORDERED STEP PROFESSIONAL GROUP

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	291U00000X	Clinical Medical Laboratory		TX

General Provider Information

NPI Number	:	1316976178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORDERED STEP PROFESSIONAL GROUP

Provider Business Mailing Address
First Line	:	3507 HORNE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6603
Country	:	US
Telephone Number	:	817-732-3062
Fax Number	:	817-732-3529

Provider Business Practice Location Address
First Line	:	3507 HORNE STREET
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6603
Country	:	US
Telephone Number	:	817-732-3062
Fax Number	:	817-732-3529

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MAEIDA YVETTE OWUSU-ANSAH
Credential	:
Telephone Number	:	817-732-3062

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/22/2020

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Directions to “ORDERED STEP PROFESSIONAL GROUP ” Practice Location

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