MEDICARE: CHARLES LENFORD HOUSE JR. CSA CST

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1649639121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LENFORD HOUSE JR. CSA CST

Provider Business Mailing Address
First Line	:	7759 GREENSWARTH LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-3607
Country	:	US
Telephone Number	:	832-967-4960
Fax Number	:

Provider Business Practice Location Address
First Line	:	7759 GREENSWARTH LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-3607
Country	:	US
Telephone Number	:	832-967-4960
Fax Number	:

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

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	02/12/2016

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