MEDICARE: SUSAN K PANZARELLA

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	332B00000X	Durable Medical Equipment & Medical Supplies	0012233	TX
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)	0072935	TX
4	335E00000X	Prosthetic/Orthotic Supplier		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531601	OTHER	TX	BLUE CROSS BLUE SHIELD
2	531483	OTHER	TX	BLUE CROSS BLUE SHIELD
3	V16521	OTHER	TN	HOMELINK

General Provider Information

NPI Number	:	1386795078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN K PANZARELLA

Provider Business Mailing Address
First Line	:	9652 FM 1960 BYPASS RD W
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4039
Country	:	US
Telephone Number	:	281-446-7771
Fax Number	:	281-446-7701

Provider Business Practice Location Address
First Line	:	9652 FM 1960 BYPASS RD W
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4039
Country	:	US
Telephone Number	:	281-446-7771
Fax Number	:	281-446-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/14/2008

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Practice Location Address:

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77338-4039

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Practice Fax: 281-446-7701

Directions to “ SUSAN K PANZARELLA ” Practice Location

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