MEDICARE: ELIDIA MANAGEMENT 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	171100000X	Acupuncturist	AC00966	TX

General Provider Information

NPI Number	:	1801085808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIDIA MANAGEMENT INC.

Provider Business Mailing Address
First Line	:	1302 WAUGH DR
Second Line	:	PMB 443
City	:	HOUSTON
State	:	TX
Zip	:	77019-3908
Country	:	US
Telephone Number	:	713-922-3022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 HULDY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-6724
Country	:	US
Telephone Number	:	713-922-3022
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	ELISABETH BOUCHARD
Credential	:	L. AC.
Telephone Number	:	713-922-3022

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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