MEDICARE: QIC MEDICAL SOLUTIONS, INC.

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	251F00000X	Home Infusion Agency	006488	TX

General Provider Information

NPI Number	:	1760633192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QIC MEDICAL SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	6671 SOUTHWEST FWY
Second Line	:	SUITE 777
City	:	HOUSTON
State	:	TX
Zip	:	77074-2212
Country	:	US
Telephone Number	:	713-621-4464
Fax Number	:	713-621-7775

Provider Business Practice Location Address
First Line	:	6671 SOUTHWEST FWY
Second Line	:	SUITE 777
City	:	HOUSTON
State	:	TX
Zip	:	77074-2212
Country	:	US
Telephone Number	:	713-621-4464
Fax Number	:	713-621-7775

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JIM RUTHERFORD
Credential	:
Telephone Number	:	713-621-4464

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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