=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093013864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANSA BHAKTI MEDLEY M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2011
-----------------------------------------------------
Last Update Date | 03/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8989 WESTHEIMER RD SUIE 314
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-782-2156
-----------------------------------------------------
Fax | 713-782-5054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8989 WESTHEIMER RD SUIE 314
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-782-2156
-----------------------------------------------------
Fax | 713-782-5054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. HANSA B MEDLEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-782-2156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | J2457
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------