MEDICARE: SHANE G LANYS MD PA

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8597B9T	OTHER	TX	MEDICARE
3	8597B9	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	86202Z	OTHER	TX	RENAISSANCE
4	1467412759	OTHER	TX	OLD NPI NUMBER
5	0034HL	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1629251137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANE G LANYS MD PA

Provider Business Mailing Address
First Line	:	7739 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2104
Country	:	US
Telephone Number	:	713-721-4114
Fax Number	:	713-721-2349

Provider Business Practice Location Address
First Line	:	7739 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2104
Country	:	US
Telephone Number	:	713-721-4114
Fax Number	:	713-721-2349

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS TIFFANY N WOOD
Credential	:
Telephone Number	:	713-721-4114

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	03/19/2008

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Directions to “SHANE G LANYS MD PA ” Practice Location

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