MEDICARE: AMERICAN HEALTH ASSESSMENTS LLC

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	363LG0600X	Gerontology Nurse Practitioner
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1497027098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH ASSESSMENTS LLC

Provider Business Mailing Address
First Line	:	2800 SHORELINE DR
Second Line	:	SUITE #120
City	:	DENTON
State	:	TX
Zip	:	76210-0128
Country	:	US
Telephone Number	:	940-383-1240
Fax Number	:	940-383-2321

Provider Business Practice Location Address
First Line	:	2800 SHORELINE DR
Second Line	:	SUITE #120
City	:	DENTON
State	:	TX
Zip	:	76210-0128
Country	:	US
Telephone Number	:	940-383-1240
Fax Number	:	940-383-2321

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAYMOND WEAVER MCCLURE II
Credential	:
Telephone Number	:	940-383-1240

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	03/20/2013

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