MEDICARE: JAMES RAY LISNE

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	341600000X	Ambulance

General Provider Information

NPI Number	:	1851540512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RAY LISNE

Provider Business Mailing Address
First Line	:	1525 VERMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1041
Country	:	US
Telephone Number	:	281-865-3195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 VERMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1041
Country	:	US
Telephone Number	:	281-865-3195
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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Directions to “ JAMES RAY LISNE ” Practice Location

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