MEDICARE: SUSAN DAVIS LST

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1972664910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DAVIS LST

Provider Business Mailing Address
First Line	:	908 SOUTHMORE AVE
Second Line	:	STE 270
City	:	PASADENA
State	:	TX
Zip	:	77502-1134
Country	:	US
Telephone Number	:	713-477-2283
Fax Number	:	713-475-5986

Provider Business Practice Location Address
First Line	:	908 SOUTHMORE AVE
Second Line	:	STE 270
City	:	PASADENA
State	:	TX
Zip	:	77502-1134
Country	:	US
Telephone Number	:	713-477-2283
Fax Number	:	713-475-5986

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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